Despite its indication in enterococcal infections, there is limited data to support the use of daptomycin in vancomycin-resistant enterococci (VRE) complicated intra-abdominal infections (IAI). With linezolid’s myelosuppressive ADR, increased use of daptomycin in complicated VRE IAI is observed. Hence, our study aims to assess outcomes amongst patients who were on daptomycin for culture-directed treatment of VRE IAI.
This is a single-center, retrospective observational study. All adult inpatients aged ≥21 years who received ≥48 hours of daptomycin for culture-directed VRE IAI from Jan 2013 - Dec 2015 were included. Patient-related demographics & treatment-related factors (daptomycin as first-line or alternative agent, time to effective antibiotic therapy, dose of daptomycin used) were analyzed. Treatment outcomes include: 14-day re-infection & 30-days all-cause mortality post-discontinuation of daptomycin (PDD), & clinical or microbiological response at the end of daptomycin therapy.
13 patients were included. Median age, dose & duration of daptomycin therapy was 61 (27-87) years old, 7 (6-10)mg/kg Q24H or renally adjusted & 16 days (2-48) respectively. Median Charlson’s score was 5 (3-8); 5 patients had septic shock; 4 had underlying malignancy while 3 had both. 6 patients were started on daptomycin as first-line definitive therapy and 3 patients had documented microbiological clearance while on daptomycin. Clearance cultures were not done for the rest. The remaining 7 patients were switched to daptomycin from other VRE-active agents; 1 patient had documented clearance during daptomycin; 6 had either no documented clearance or had documented clearance with linezolid/ tigecycline. Whilst on daptomycin for IAI, clinical response was observed in 9 (69%) patients and 2 patients died. None had 14-day re-infection. Within 30-day PDD, 4 additional patients died. 7 patients were discharged well.
30-days all-cause mortality PDD was 46%, and could be confounded by the severity of illness. Nevertheless, a clinical response rate of 69% & possibility of microbiological clearance while on daptomycin suggests that it could be a promising alternative for the treatment of VRE IAI.
B. W. Teo,
A. L. Kwa, None