Effect of Daptomycin Dose on the Outcome of Vancomycin-Resistant, Daptomycin-Susceptible Enterococcus faecium Bacteremia.
Treatment options for vancomycin-resistant enterococci (VRE) bloodstream infection (BSI) are limited. Daptomycin, although not currently approved for this indication, is frequently used for the treatment of VRE-BSI. Its optimal dose still needs to be determined.



We conducted a prospective, observational, cohort study during 2010-2015. We included patients who received a daptomycin dose of ≥6 mg/kg for the treatment of VRE-BSI caused by daptomycin-susceptible VRE. The primary endpoint was 14-day mortality, and multivariable logistic regression was performed for outcome analysis.



We included 112 patients treated with daptomycin for VRE-BSI and with evaluable clinical outcomes. The daptomycin minimum inhibitory concentration (MIC) was 4 mg/L in 78 (69.6%) and ≤2 mg/L in 34 (30.4%) isolates. The overall mortality was 40/112 (35.7%). The unadjusted mortality was 18/36 (50.0%) for a daptomycin dose of <7 mg/kg, 17/51 (33.3%) for a dose of 7-9 mg/kg, and 5/25 (20%) for a dose of ≥9 mg/kg (P = .05). The best outcomes were associated with a daptomycin dose of ≥9 mg/kg compared to doses of <7 mg/kg (adjusted odds ratio [aOR], 10.57; 95% confidence interval [CI], 2.25-49.62; P=.003) and 7-9 mg/kg (aOR, 5.01; 95% CI, 1.14-21.98; P=.03). There was no significant difference in mortality with respect to the daptomycin MIC. There was no association between daptomycin dose and elevated creatinine kinase.



Higher daptomycin doses (≥9 mg/kg) were associated with lower mortality in patients with VRE-BSI. Our results suggest that higher daptomycin doses need to be considered for VRE-BSI treatment.
Graduate Institute of Clinical Medicine, College of Medicine, Taipei, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Yu-Chung
YC
Chuang
Department of Economics, National Chengchi University, Taiwan.
Hsin-Yi
HY
Lin
Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
Pao-Yu
PY
Chen
Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
Chi-Ying
CY
Lin
Graduate Institute of Clinical Medicine, College of Medicine, Taipei, Taiwan.
Jann-Tay
JT
Wang
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Yee-Chun
YC
Chen
Graduate Institute of Clinical Medicine, College of Medicine, Taipei, Taiwan.
Shan-Chwen
SC
Chang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D017576:Daptomycin / Q000008:administration & dosage*; D016984:Enterococcus faecium / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects / Q000302:isolation & purification*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D017576:Daptomycin
bacteremia.; daptomycin; dose; mortality; vancomycin-resistant enterococci