Antibiotische Therapie von Enterokokken-Infektionen in der Gastroenterologie mit Daptomycin − erste Erfahrungen aus der Registerstudie EU-CORE (European Cubicin® Outcomes Registry and Experience)

Abstract

Enterococci are a frequent cause of nosocomial infections in gastroenterology. The increase of Enterococcus faecium infections with development of resistance to gentamicin and vancomycin as well as possible linezolid resistance require alternative antibiotic therapies. Study data show that daptomycin, a highly bactericidal antibiotic is effective in enterococcal infections. However, in Germany daptomycin is so far only approved for the treatment of complicated skin and soft tissue infections, bacteremia and infective endocarditis caused by Staphylococcus aureus. In the Department of Internal Medicine I, University Hospital Halle (Saale) from May 2 009 to April 2 010 all gastroenterological patients with evidence of invasive enterococcal infection received intravenous daptomycin treatment at inclusion in the European Cubicin® Outcomes Registry and Experience (EU-CORE). Gastroenterological diseases treated were necrotising pancreatitis, infected pancreatic pseudocysts, abscesses, obstructive cholangitis and sepsis. The clinical outcome was retrospectively detected by protocol-defined criteria. A total of 13 patients (8 male, 5 female, median age 59 years) with microbiologically assured enterococcal infections (10 × E. faecium, including 1 × VRE, 6 × E. faecalis, including double infections) were treated with intravenous daptomycin (6 mg per kg body weight). In the presence of polymicrobial infections (10 of 13 patients), an additional anti-infective therapy was initiated according to sensitivity testing. Concomitantly a direct focus approach with stenting, puncture or drainage was performed. The clinical cure rate was 92 % (12 of 13 patients). One patient died from a non-surgically uncontrollable malignancy (Klatskin tumour Bismuth IIIb). There were no adverse events. These results allow us to conclude that antibiotic therapy with daptomycin in invasive or bacteraemic enterococcal infections leads to high cure rates (up to 90 % and more) when concomitant and adequate focus relief is performed. Larger clinical studies to obtain an extended drug approval are desirable.

Epidemiology and Resistance Patterns of Bacterial and Fungal Colonization of Biliary Plastic Stents: A Prospective Cohort Study

“…However, taking into account the azole resistance rate of 32.9%, significant failure rates of fluconazole-based empirical antifungal therapies for Candida infections have to be considered. It is well known that numerous interventional ERC procedures accompanied by antibiotic therapy predispose for increased antimicrobial resistance in patients with acute cholangitis [ 25 , 27 ], and enterococcal species are often involved in this process [ 42 , 43 ]. Therefore, adequate microbiological diagnosis is essential and should include analysis of the extracted stents.…”

Real-World Treatment of Enterococcal Infections with Daptomycin: Insights from a Large European Registry (EU-CORE)

“…It has been previously shown that daptomycin (6 mg/kg/day) was highly effective against susceptible and multidrug-resistant E. faecalis and E. faecium in vitro and also in a rat model of experimental endocarditis [ 20 ]. Moreover, treatment with daptomycin in patients with invasive or bacteremic enterococcal infections leads to higher frequency of cure (up to 90% or more) when concomitant and adequate focus relief was performed [ 21 ].…”

Sepsis secondary to multifocal Enterococcus faecium infection

“…E faecium exhibits strong adaptability to the environment and shows an intrinsic resistance to cephalosporins, aminoglycosides, trimethoprim/sulfamethoxazole, and clindamycin. [ 24 ] Moreover, an increase in dosage or the number of antibiotics in the treatment regimen may further enhance the drug resistance of E faecium . [ 15 ] A hospital-based survey of drug resistance in our hospital in 2017 (Table 2 ) showed E faecium was sensitive to only vancomycin, linezolid, and tigecycline, and these findings were consistent with the susceptibility results in the present case.…”