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Daptomycin Prevention of Vancomycin-Resistant Enterococcus Bacteremia in Colonized Patients With Acute Myelogenous Leukemia

Levitt, Laura A. MD*; Yacoub, Abraham T. MD; Khwaja, Sara I. MD, MS; Vincent, Albert L. PhD; Sandin, Ramon L. MD, MS, FCAP§; Greene, John N. MD, FACP

Infectious Diseases in Clinical Practice: March 2014 - Volume 22 - Issue 2 - p 89–91
doi: 10.1097/IPC.0b013e31829ff3b0
Original Articles

Abstract: Vancomycin-resistant enterococci (VRE) are a significant cause of bloodstream infections (BSIs) and mortality in patients with acute myelogenous leukemia undergoing chemotherapy or allogeneic hematopoietic stem cell transplant (HSCT). Fecal colonization with VRE is a major risk factor for development of VRE BSIs in neutropenic patients with a hematologic malignancy. Mucosal damage and neutropenia from high-dose chemotherapeutic agents allow enteric VRE to enter the systemic circulation via translocation resulting in a BSI. Recent studies have shown that 13.4% of VRE-colonized cancer patients and 34.2% of VRE-colonized patients who underwent allogeneic hematopoietic stem cell transplant developed VRE BSI, and a large percentage of these patients die from this infection. Here, we show that empiric or prophylactic treatment with daptomycin significantly reduces the percentage of VRE-colonized patients with acute myelogenous leukemia who will go on to develop BSIs after immunosuppressive treatment. In addition, we found a significant reduction in mortality caused by VRE BSIs in this patient population.

From the *Department of Pediatrics, College of Medicine, University of South Florida; †H. Lee Moffitt Cancer Center and Research Institute; ‡Division of Infectious Diseases and International Medicine, Department of Internal Medicine, College of Medicine, University of South Florida; §Clinical Microbiology and Virology Laboratories, H. Lee Moffitt Cancer Center and Research Institute; University of South Florida College of Medicine; and ∥Infectious Diseases, H. Lee Moffitt Cancer Center and Research Institute; University of South Florida College of Medicine, Tampa, FL.

Correspondence to: John N. Greene, MD, FACP, Chief, Infectious Diseases and Hospital Epidemiologist, H. Lee Moffitt Cancer Center and Research Institute; Professor of Internal Medicine and Interdisciplinary Oncology, University of South Florida College of Medicine, 12902 Magnolia Drive–FOB 3, Tampa, FL 33612. E-mail: john.greene@moffitt.org.

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

© 2014 by Lippincott Williams & Wilkins.