Daptomycin pulmonary eosinophilia (DPE) has been described as a rare event. Since the Food and Drug Administration (FDA) first described the syndrome which occurs about 3 weeks after starting the drug, it continues to be a miss diagnosed. Most outpatient antibiotic treatment (OPAT) programs focus on screening for CPK elevations. We describe an unusual increase in DPE at our center including acute reactions on re-exposure to daptomycin.
Retrospective review from local VA pharmacy and OPAT database of adverse drug events (ADE) with daptomycin from 2010 to 4/2018. Data evaluated include, age, gender, weight, body mass index (BMI), daptomycin dosing, indication for use, duration of therapy, time to symptom onset, Creatinine clearance, white cell count (WCC), %eosinophilia (%eos), admission to intensive care unit (ICU), and clinical outcomes or interventions.
There were 363 unique initiations of Daptomycin in the time period. There were 17 DPE (5%) and 3 CPK (0.6%) events in that time period. The medians for all DPE was; Age 68 years (range 55-95), BMI 29 m/kg2 (range 21-49.5), daptomycin dose 500 mg (> 7 mg/kg), baseline CrCl 35.5 ml/min, eosinophilia at onset of DPE 9% (8-44%), and duration of therapy to onset was 21 days (1-33). All recovered on removal of daptomycin, but 5 patients required adjunctive corticosteroid therapy. Four patients had a severe and novel hyperacute DPE within 48 hours of a new initiation of daptomycin therapy. All 4 patients had prior exposure to daptomycin in the last 12 months. They presented with hypoxic respiratory failure, abnormal chest xrays and/or CT chest scans, with preceding systemic fevers and fatigue after the first dose. All had low grade %eos (3-5%) on prior use, and all recovered rapidly with discontinuation of daptomycin.
DPE may be underreported and is associated with doses of 500 mg or > 7 mg/kg, with CrCl <35 ml/min and older age. Of concern are the new cases of hyperacute DPE within 48 hours of re-exposure to daptomycin that we have seen, who had prior low-grade eosinophilia. Close monitoring of these factors may be warranted in at risk individuals.
G. N. Forrest, None