Successful treatment of vancomycin-resistant Enterococcus faecium pyelonephritis with daptomycin during pregnancy.
OBJECTIVE
To report successful treatment using daptomycin for pyelonephritis associated with vancomycin-resistant Enterococcus faecium (VRE) in a 27-week pregnant woman.


METHODS
A 20-year-old 27-week pregnant patient with a history of spina bifida, neurogenic bladder, and multiple hospitalizations for recurrent urinary tract infections (UTIs) was diagnosed with pyelonephritis. She was treated with daptomycin 260 mg (4 mg/kg) daily for 14 days on the basis of a urine culture that revealed E. faecium resistant to ampicillin, nitrofurantoin, and vancomycin. All cultures following treatment revealed no growth, and the patient as well as the neonate displayed no adverse effects.


CONCLUSIONS
VRE UTIs can be treated safely in pregnancy with nitrofurantoin, if the organism is susceptible. Other viable options in the treatment of VRE, including linezolid, doxycycline, and quinupristin/dalfopristin, have lower urinary concentrations, teratogenic risk, or limited findings regarding their safety in pregnancy. Daptomycin was selected in this case due to its efficacy in the treatment of VRE, high urinary concentrations, pregnancy category B, and one case report indicating its successful use in pregnancy.


CONCLUSIONS
Treatment of VRE in pregnancy can be challenging due to the teratogenicity or unknown safety of available options. The use of daptomycin in our patient enabled a successful outcome of multidrug-resistant E. faecium in a complicated pregnant patient without observed neonatal abnormalities.
Shea
Katherine
K
Department of Pharmacy, Sentara Norfolk General Hospital, Norfolk, VA, USA. kshea@clarian.org
Hilburger
Esther
E
Baroco
Allison
A
Oldfield
Edward
E
D000328:Adult; D017576:Daptomycin / Q000494:pharmacology / Q000627:therapeutic use*; D016984:Enterococcus faecium / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000382:microbiology; D011704:Pyelonephritis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D020713:Vancomycin Resistance / Q000187:drug effects* / Q000502:physiology
D017576:Daptomycin