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Open Access Highly Accessed Research article

Use of daptomycin in the treatment of vancomycin-resistant enterococcal urinary tract infections: a short case series

Divya Pradeep Ramaswamy14, Maria Amodio-Groton2 and Stephen J Scholand35*

Author Affiliations

1 Department of Internal Medicine, St. Mary’s Hospital, Waterbury, Connecticut 06706, USA

2 Cubist Pharmaceuticals, Inc., Lexington, Massachusetts 02421, USA

3 Division of Infectious Diseases, St. Mary’s Hospital, Waterbury, Connecticut 06706, USA

4 Current affiliations: Toledo Hospital, Toledo, Ohio 43606, USA

5 Current affiliations: Cornell Scott Hill Health Center, New Haven, Connecticut 06519, USA

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BMC Urology 2013, 13:33  doi:10.1186/1471-2490-13-33

Published: 16 July 2013

Abstract

Background

Vancomycin-resistant enterococci are a leading cause of hospital-acquired urinary tract infection and a growing concern for the clinician. The aim of this study was to evaluate the effectiveness of daptomycin in the treatment of patients with vancomycin-resistant enterococcal urinary tract infection treated in our 200-bed community-based institution.

Methods

Patients with confirmed symptomatic vancomycin-resistant enterococcal urinary tract infection identified by infectious disease consultation between January 1, 2007, and December 8, 2009, vancomycin-resistant enterococci–positive urine culture, and urinary symptoms and/or pyuria on urinalysis, and treated with daptomycin, were included in this case series. Daptomycin was generally administered at a planned dosage regimen of ≥5 mg/kg every 24 hours in patients with normal to moderately impaired kidney function or every 48 hours in patients with severe kidney disease. Microbiologic cure was defined as eradication of vancomycin-resistant enterococci in urine cultures taken after the completion of daptomycin treatment. Clinical cure was defined by symptom resolution, as assessed by the infectious disease clinician caring for the patient.

Results

Included in this case series are 10 patients who received daptomycin for confirmed vancomycin-resistant enterococcal urinary tract infection. Patients had a history of extensive hospital stays. Chart review revealed that all levels of kidney function (3, 2, 3, and 2 patients with kidney disease classified as normal, mild, moderate, and severe/kidney failure, respectively) were represented in the sample and that patients with (n = 5) or without (n = 5) previous urinary tract infection and with (n = 3) or without (n = 7) Foley catheters were included. Treatment with daptomycin achieved clinical cure and vancomycin-resistant enterococcal eradication in all cases in this series.

Conclusion

Treatment with daptomycin was well tolerated and effective in all patients in this series, regardless of renal function, history of urinary tract infection, or Foley catheter use. This study adds to emerging clinical evidence that daptomycin is a valuable treatment for vancomycin-resistant enterococcal urinary tract infection.

Keywords:
Daptomycin; Enterococcus faecalis; Enterococcus faecium; Urinary tract infection; Vancomycin-resistant enterococci