Use of Daptomycin in the Treatment of Vancomycin-Resistant Enterococcal Urinary Tract Infections

A Short Case Series

Divya Pradeep Ramaswamy; Maria Amodio-Groton; Stephen J Scholand

Disclosures

BMC Urol. 2013;13(33) 

In This Article

Results

Between January 1, 2007, and December 8, 2009, we identified 10 patients with VRE UTIs who were treated by daptomycin-based regimens at our institution. Baseline characteristics of these patients are shown in Table 1; all patients had cystitis. As is apparent from the medical histories, most of the VRE UTIs were acquired in the hospital. In addition, the patients had a variety of risk factors typical for VRE infections, such as prolonged hospital stays, multiple previous UTIs, uropathy including the requirement for a long-term Foley catheter, and multiple past courses of antibiotics.[7]

Table 2 presents the details of the daptomycin-based regimens for the management of VRE UTIs in our selected patient cases. Dosages used were based on our empirical experience because there are no recommendations in the literature with regard to daptomycin use in the treatment of patients with VRE UTIs. Because of the high therapeutic index and the fixed vial size for daptomycin (500 mg), some variability in actual per-weight dosing occurred. The unusually high dose used in patient 3 (13 mg/kg every 24 hours in a 30-year-old man with quadriplegia) is explained by the concomitant management of a Staphylococcus spp. bacteremia.

Daptomycin-based courses of antibiotic treatment achieved clinical cure and successful eradication of VRE in all patients in this representative sample of a diverse patient population in our medical facility (Table 2). Indwelling catheters are common sites of infection, and similar results of daptomycin treatment were observed in patients with and without Foley catheters. Daptomycin was effective at eradicating VRE in patients regardless of whether they had had previous UTIs. Additionally, daptomycin eradicated VRE regardless of the level of renal function. Overall, daptomycin was well tolerated, and no reports of adverse events such as alteration of kidney function, muscle weakness or pain, and elevated levels of CPK enzymes were included. For most patients, CPK levels were measured at the time of daptomycin therapy initiation and once or twice more in the next 7 to 10 days. Even for the patient receiving the highest dose (13 mg/kg, patient 3), no elevation was above the normal CPK range.

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