2444. Incidence of Daptomycin Toxicity Among Patients with Vancomycin-resistant Enterococcus Blood Stream Infections
Session: Poster Abstract Session: Treatment of AMR Infections
Saturday, October 6, 2018
Room: S Poster Hall


Daptomycin (DAP) is a lipopeptide antibiotic and is first line treatment for infections caused by Vancomycin-resistant Enterococcus (VRE). DAP is considered a safe antimicrobial agent, most commonly causing elevation of CPK. The historical incidence of DAP toxicity reported in the literature is low, ranging between 3 to 9%. We aim to describe the incidence of DAP toxicity among patients with VRE blood stream infection (BSI).


This is a retrospective cohort study conducted in a tertiary hospital in Cleveland-Ohio. We included all consecutive adult patients diagnosed with VRE BSI treated with DAP between November 2011 and January 2015. Patients were grouped based on dose of DAP received (Group 1: <=6mg/kg and Group 2 >= 8mg/kg). Patient data was obtained from the microbiology department database, pharmacy information technology services and electronic medical records (EMR) (Table 1).


During the study period, a total of 217 patients with VRE BSI were treated with DAP. (Table 1) The number of patients that received DAP dose of <=6mg/kg was 192 (88%), compared to 25 patients that received a DAP dose of >=8mg/kg (12%). The total incidence of DAP toxicity was present in only 3 patients (1.4%); and of those, only 2 patients developed CPK elevation leading to rhabdomyolysis requiring discontinuation of DAP (Maximum CPK value was 3142 U/L and 987 U/L for each case). The other patient developed a rash thought to be secondary to DAP. Of note, all 3 patients that developed DAP toxicity, received doses of <=6mg/kg.


In this retrospective cohort study of patients with VRE BSI treated with DAP, the incidence of DAP toxicity was only 3 cases out of 217 patients. All of these patients received doses of <=6mg/kg of DAP. This is lower than what is reported in the literature. DAP was well tolerated and the development of side effects did not seem to be related to the dose.

Maria X Bueno Rios, MD1, Luis A Shimose, MD2, Vasilios Athans, PharmD, BCPS3, Stephanie Bass, PharmD3, Joshua Otiso, MPH, MLS (ASCP)4, Manshi Li, MS5, Xiaofeng Wang, PhD5, Abhijit Duggal, MD, MPH, MSc2, Sandra S. Richter, MD4 and Christopher Kovacs, MD1, (1)Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, (2)Department of Critical Care Medicine, Cleveland Clinic, Cleveland, OH, (3)Department of Pharmacy, Cleveland Clinic, Cleveland, OH, (4)Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, (5)Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH


M. X. Bueno Rios, None

L. A. Shimose, None

V. Athans, None

S. Bass, None

J. Otiso, None

M. Li, None

X. Wang, 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.