title: Daptomycin in the treatment of vancomycin-resistant Enterococcus faecium bacteremia in neutropenic patients.
abstract: OBJECTIVE
  Vancomycin resistant enterococcal (VRE) blood stream infection (BSI) in neutropenic patients is associated with poor outcome. We report our experience in treating VRE BSI in febrile, neutropenic patients with daptomycin, a recently licensed lipopeptide with bactericidal activity against VRE.
  
  
  METHODS
  Patients with fever, neutropenia and VRE BSI were treated with more than one dose of daptomycin (either 6 mg/kg/day or 4 mg/kg/day) in an open label, emergency-use trial. Patients were then assessed for clinical and microbiological cures and survival. MIC's of isolates to daptomycin were determined.
  
  
  RESULTS
  Nine febrile, neutropenic patients with VRE BSI received daptomycin. Four of 9 courses (44%) had clinical and/or microbiologic cure. Two of the 5 who failed cure died within 3 days of initiation of daptomycin. Five subjects survived to 30 days after the onset of BSI.
  
  
  CONCLUSIONS
  Use of daptomycin in neutropenic patients with VRE BSI deserves further study as a treatment for VRE BSI in neutropenic patients.
authors.affiliation: Division of Geographic Medicine and Infectious Diseases, Box 041, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, USA. dpoutsiaka@tufts-nemc.org <dpoutsiaka@tufts-nemc.org>
authors.forename: Debra D
authors.initials: DD
authors.lastname: Poutsiaka
authors.forename: Serena
authors.initials: S
authors.lastname: Skiffington
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Miller
authors.forename: Susan
authors.initials: S
authors.lastname: Hadley
authors.forename: David R
authors.initials: DR
authors.lastname: Snydman
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy*; D017576:Daptomycin / Q000627:therapeutic use*; D016984:Enterococcus faecium / Q000302:isolation & purification / Q000472:pathogenicity*; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000601:surgery; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D033581:Stem Cell Transplantation; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin