Daptomycin for the treatment of bacteraemia due to vancomycin-resistant enterococci

Abstract

Treatment of severe infections caused by vancomycin-resistant enterococci (VRE) is challenging due to the scarcity of reliable therapeutic alternatives. In this context, daptomycin (DAP), a lipopeptide antibiotic, has emerged as an interesting alternative as it is one of the few compounds that retain in vitro bactericidal activity against VRE isolates, although it has not been approved for this purpose by regulatory agencies. In this review, we will summarise the clinical, animal and in vitro evidence evaluating the efficacy of DAP for the management of deep-seated VRE infections. In addition, we will address important clinical concerns such as the emergence of DAP resistance during therapy and reports of therapeutic failure with DAP monotherapy. Finally, we will discuss possible future strategies (such as the use of higher doses and/or combination therapies) to optimise the use of this antibiotic against VRE.

Predictive utility of swab screening for vancomycin-resistant Enterococcus in selection of empiric antibiotics for Enterococcus sterile-site infections: a retrospective cohort study

“…12 Once the prevalence of vancomycin resistance in Enterococcus sterilesite culture isolates increases beyond 1%, the post-test probability of VRE sterile-site culture isolates in a patient with a prior positive result on VRE swab screening exceeds 20%, which necessitates empiric coverage with agents such as linezolid or daptomycin. 1,6,30 This is the most important implication of our study to clinical practice.…”

In Vitro Activity of Daptomycin in Combination with β-Lactams, Gentamicin, Rifampin, and Tigecycline against Daptomycin-Nonsusceptible Enterococci

“…Synergy between daptomycin and gentamicin, for E. faecium isolates with high-level susceptibility to gentamicin, has been noted previously (41), but little to no clinical data exist for this combination (42). Unlike the case with the glycopeptides (43), it would appear that high-level gentamicin resistance does not necessarily abolish in vitro synergy, as was seen for isolate Efm16; however, this interaction requires further evaluation, and no data exist to suggest that this may be the case in vivo.…”

Vancomycin-Resistant Enterococci

“…The reason is that DAP generally seems to retain bactericidal activity against susceptible VRE strains, at least in vitro, and the toxicity profile is favorable in infections that require prolonged administration. 119 However, robust clinical evidence to support the use of DAP over linezolid (an FDA-approved drug) is lacking. Recent meta-analyses have tried to address this issue and attempted to summarize the available clinical data on the treatment of VRE bacteremia with linezolid compared with DAP.…”