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Daptomycin Therapy for Vancomycin-Resistant Enterococcus Bacteremia in Neutropenic Patients With Hematologic Malignancies and Hematopoietic Cell Transplantation Recipients

Otsuka, Mai MD*; Kharfan-Dabaja, Mohamed A. MD*†; Wetzstein, Gene A. PharmD, BCOP; Quilitz, Rod E. PharmD, BCOP§; Sandin, Ramon L. MD, MS, FCAP*∥; Greene, John N. MD, FACP

Infectious Diseases in Clinical Practice: September 2012 - Volume 20 - Issue 5 - p 319–325
doi: 10.1097/IPC.0b013e3182639da4
Original Articles

Background: Vancomycin-resistant Enterococcus fascium (VRE) are rapidly emerging nosocomial pathogens in the United States and worldwide. Vancomycin resistance is recognized to be an independent risk factor for increased morbidity and mortality among patients with enterococcal bloodstream infections (BSI); thus, early appropriate therapy is vital in improving outcomes. We report our experience in treating VRE BSI in patients with hematologic malignancies with daptomycin, a cyclic lipopeptide antibiotic with bactericidal activity against VRE.

Methods: We performed retrospective chart review for patients with hematologic malignancies treated with daptomycin for a VRE BSI from January 2005 to May 2009. Patients were assessed for microbiological cure and survival. Patients were identified using a computerized clinical microbiology laboratory records.

Results: Of 74 patients with a VRE BSI, 40 patients (31 male patients; median age, 61 years) met criteria and were included in the study. In this series, 35.6% of the patients had received a hematopoietic stem cell transplant, and 57.8% of the patients were neutropenic. Vancomycin-resistant Enterococcus BSI occurred at a median of 20 days (4–109 days) of neutropenia among these patients. The patients were treated with daptomycin monotherapy (62.5%) or daptomycin plus other antimicrobial(s) (37.5%). For those who were successfully treated with daptomycin alone, the median duration of therapy was 9 days (1–36 days). Overall, 92.3% of the patients achieved a microbiological cure, which was evident at a median of 1 day (1–16 days) after the initiation of therapy.

Conclusion: Daptomycin is an effective agent for the treatment of VRE BSI. For both daptomycin monotherapy or combination therapy, we would recommend an intravenous dose of 8 mg/kg once daily for 10 to 14 days.

From the *College of Medicine, University of South Florida, Tampa, FL; †Department of Blood and Marrow Transplantation, and Bone Marrow Transplant Fellowship Program, ‡Clinical Services, §Infectious Disease, MCC-PHARM, ∥Clinical Microbiology and Virology Laboratories and ¶Section of Infectious Diseases, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL.

Correspondence to: John N. Greene, MD, FACP, Infectious Diseases, Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB-3, Tampa, FL 33612-9497. E-mail: john.greene@moffitt.org.

The authors have no funding or conflicts of interest to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.