Eosinophilic Syndromes Associated With Daptomycin Use: Re-exposure Hypersensitivity Pneumonitis and Prior Peripheral Eosinophilia

Abstract

Background Daptomycin pulmonary eosinophilia (DPE) has been well described in case reports and reporting from the Food and Drug Administration. We report 3 eosinophilic syndromes associated with daptomycin use. Methods This is a retrospective review of all patients who received daptomycin (inpatient or outpatient) from 2010 to 2020 at the Veterans Affairs Portland Healthcare System. Patients who developed DPE while receiving daptomycin were evaluated to determine risk factors. Data collected included daptomycin dose and duration, body mass index, creatinine clearance, and peripheral eosinophilia. Results Of 330 patients who received daptomycin, 81.5% developed a peripheral eosinophilia, with 109 (33%) developing peripheral eosinophilia ≥5%. Fifty-one (16%) met criteria for DPE. Primary DPE occurred in 38 of the 51 patients with a median 26 days of treatment, and 49% had peripheral eosinophilia ≥5%. Re-exposure DPE occurred in the other 13 patients and occurred a median of 3 days after initiation of daptomycin. The presence of an elevated peripheral eosinophilia of ≥5% during daptomycin usage was significantly associated with primary (odds ratio [OR], 2.23; 95% CI, 1.2–4.09; P = .008) and re-exposure DPE (OR, 12; 95% CI, 1.6–103; P = .003). All patients recovered after withdrawal of daptomycin without complications. Conclusions There are 3 daptomycin eosinophilic syndromes: peripheral eosinophilia, primary DPE occurring about 4 weeks into therapy, and re-exposure DPE. Elevated peripheral eosinophilia ≥5% was a risk factor for both primary and re-exposure DPE, but still identified about half the cases. Peripheral eosinophilia should be carefully monitored during daptomycin treatment, and clinicians should be aware that prior eosinophilia may predict an acute pulmonary reaction upon daptomycin re-exposure.

Daptomycin-induced eosinophilic pneumonia

“…8 Furthermore, a retrospective review of 330 patients found that 81.5% of patients with DIEP demonstrated 5% or greater peripheral eosinophilia, suggesting the utility of peripheral eosinophilia in the diagnosis of DIEP. 9 The case patient had 5.8% peripheral eosinophilia, supporting the final diagnosis of DIEP.…”

“…Although 25% or greater eosinophils on BAL is one of the criteria for diagnosing DIEP, one literature review found that fewer than 50% of patients reviewed had greater than 25% eosinophils on BAL 8. Furthermore, a retrospective review of 330 patients found that 81.5% of patients with DIEP demonstrated 5% or greater peripheral eosinophilia, suggesting the utility of peripheral eosinophilia in the diagnosis of DIEP 9. The case patient had 5.8% peripheral eosinophilia, supporting the final diagnosis of DIEP.…”

A Pharmacovigilance Analysis of Daptomycin Use Based on CLSI Susceptible Dose-Dependent Category

“…Peripheral blood eosinophilia was defined as an eosinophil count > 1% of the total white blood cell count. Daptomycin-related peripheral blood eosinophilia was defined as an eosinophil count ≥ 5% of the total white blood cell count on two consecutive blood draws [ 10 ]. Daptomycin-induced eosinophilic pneumonitis was categorized as definite, probable, or unlikely, using criteria previously defined in the literature.…”

Update on Staphylococcus aureus bacteraemia

“…In summary, we present and review contemporary studies of SAB across a range of topics not limited to epidemiology, clinical features, multiple positive blood cultures, antibiotic choice and duration. SAB is complex and there are many important aspects that we were not able to explore further at this time including a study with eosinophilia with daptomycin [40], use of oral stepdown therapy with clindamycin [41], improvement of diagnosis using fluorodeoxyglucose positron emission tomography/ computed tomography (FDG-PET/CT) [42,43], source control such as with removal of cardiac implantable electronic devices associated with decreased mortality [44], the importance of serial negative blood cultures [45 & ], and the significance of Staphylococcus aureus bacteriuria in patients with SAB [46 & ]. In addition, optimized use of clinical scoring systems to stratify patients for therapy or best utilize echocardiography resources is a major area of investigation that could merit its own review [47][48][49][50][51][52][53][54].…”