2441. Outcomes of Patients with Vancomycin-resistant Enterococcus Blood Stream Infections (BSI) Treated with Daptomycin
Session: Poster Abstract Session: Treatment of AMR Infections
Saturday, October 6, 2018
Room: S Poster Hall

Background:

Reports of poor outcomes in patients (pts) infected with VRE strains with daptomycin (DAP) minimum inhibitory concentrations (MIC) near the susceptible breakpoint (<=4 μg/ml) are noted in the literature. We assessed the relationship of clinical outcomes for pts treated with DAP to the initial MIC.

Methods:

Retrospective study of consecutive adult pts with VRE BSI treated with DAP for at least 48 hrs (Nov 2011 – Jan 2015) in a tertiary hospital in Cleveland, OH. Pts were grouped based on the initial DAP MIC (MIC<=2 μg/ml and MIC=4 μg/ml) determined by a commercial broth microdilution method (Sensititre). Demographic and clinical data was extracted via EMR. Outcomes for all-cause mortality at 30 days (30-D Mortality) and 90 days (90-D Mortality), 30-day mortality attributed directly to VRE BSI (30-D Mortality VRE) and microbiological failure (MF) were measured. MF was defined as duration of bacteremia >=4 days after at least 48 hours of DAP use and achievement of source control when possible. We also assessed the impact of concomitant β-lactam use on MF.

Results:

A total of 192 pts were identified. Baseline characteristics are shown in Table 1. Outcomes for MF, 30-D Mortality VRE, 30-D Mortality and 90-D Mortality are shown on Table 2. Impact of concomitant β-lactam use on MF is shown in Figure1.

Conclusion:

In this retrospective study, MF and mortality were not significantly higher for BSI caused by VRE with DAP MICs of 4 μg/ml, regardless of concomitant β-lactam use.

Luis A Shimose, MD1, Maria X Bueno Rios, MD2, Vasilios Athans, PharmD, BCPS3, Stephanie Bass, PharmD3, Manshi Li, MS4, Xiaofeng Wang, PhD4, Joshua Otiso, MPH, MLS (ASCP)5, Abhijit Duggal, MD, MPH, MSc1, Sandra S. Richter, MD5 and Christopher Kovacs, MD2, (1)Department of Critical Care Medicine, Cleveland Clinic, Cleveland, OH, (2)Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, (3)Department of Pharmacy, Cleveland Clinic, Cleveland, OH, (4)Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, (5)Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH

Disclosures:

L. A. Shimose, None

M. X. Bueno Rios, None

V. Athans, None

S. Bass, None

M. Li, None

X. Wang, None

J. Otiso, None

A. Duggal, None

S. S. Richter, bioMerieux: Grant Investigator , Research grant . BD Diagnostics: Grant Investigator , Research grant . Roche: Grant Investigator , Research grant . Hologic: Grant Investigator , Research grant . Diasorin: Grant Investigator , Research grant . Accelerate: Grant Investigator , Research grant . Biofire: Grant Investigator , Research grant .

C. Kovacs, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.