Daptomycin non-susceptible Enterococcus faecium in leukemia patients: Role of prior daptomycin exposure

Abstract

Summary Objectives We sought to determine the association between previous daptomycin exposure and daptomycin non-susceptible Enterococcus faecium (DNSEf) bloodstream infections (BSI) in adult leukemia patients. Methods We retrospectively identified adult (≥ 18 years old) leukemia patients with Enterococcus spp. bacteremia at The University of Texas MD Anderson Cancer Center (MDACC) from 6/1/2013 to 7/22/2015. Antimicrobial susceptibility and previous antibiotic exposure within the 90 days prior to bacteremia were collected. Classification and Regression Tree (CART) analysis was used to identify the most significant breakpoint between daptomycin exposure and DNSEf. Results Any amount of daptomycin received within the 90 days preceding BSI was significantly associated with isolation of DNSEf compared to daptomycin susceptible E. faecium (DSEf) (88% vs. 44%, respectively, p<0.01). CART analysis identified receiving ≥ 13 days of daptomycin in the preceding 90 days as most significantly correlated with DNSEf (60% vs. 11%, relative risk [RR] 5.31, 95% Confidence interval [CI] 2.36–11.96, p < 0.01). Conclusions Prior daptomycin exposure for ≥ 13 days within 90 days preceding BSI was significantly associated with isolation of DNSEf BSI in adult leukemia patients at our institution. Antimicrobial stewardship initiatives aimed at minimizing daptomycin exposure in high-risk patients may be of significant benefit in limiting the emergence of DNSEf.

Treatment of Multidrug-Resistant Vancomycin-Resistant Enterococcus faecium Hardware-Associated Vertebral Osteomyelitis with Oritavancin plus Ampicillin

“…VRE is one of the most difficult-to-treat pathogens, and daptomycin is often considered the drug of choice for the treatment of serious VRE infections. However, daptomycin is also for several other indications, and prior exposure to daptomycin for any reason can lead to subsequent daptomycin-resistant VRE (14). This case highlights this key point, wherein brief exposure to daptomycin for a complicated MRSA bacteremia likely contributed to the development of a hardware-associated spinal infection caused by daptomycin-resistant VRE.…”

Antimicrobial treatment impacts resistance in off-target populations of a nosocomial bacterial pathogen: a case-control study

“…Daptomycin resistance has been shown to arise within patients during treatment [19]. Additionally, a number of studies have reported prior daptomycin treatment as a key risk factor for infection with daptomycin resistant VRE [20][21][22], which is consistent with offtarget selection. Finally, transmission of VR E. faecium is common in hospital settings, meaning resistance that arises in one patient may pose a threat to others.…”

Choosing the appropriate pharmacotherapy for multidrug-resistant Gram positive infections

“…Nowadays, no data are present in the literature on efficacy of fidaxomicin in patients with severe CDI, so in patients with severe disease metronidazole should be added. Despite the fact that resistance to DAP among staphylococci and enterococci is uncommon, some studies highlight the issue of increasing resistance [17][18][19]. Otherwise, we recommend high-dose DAP in association with CPT, independently to DAP susceptibility test.…”