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Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e31829ff3b0
Original Articles

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

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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.

Copyright © 2013 by Lippincott Williams & Wilkins

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