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Daptomycin exposure precedes infection and/or colonization with daptomycin non-susceptible enterococcus
Journal article   Open access   Peer reviewed

Daptomycin exposure precedes infection and/or colonization with daptomycin non-susceptible enterococcus

Jeremy Storm, Daniel Diekema, Jennifer Kroeger, Sarah Johnson and Birgir Johannsson
Antimicrobial Resistance and Infection Control, Vol.1(1), pp.19-19
05/29/2012
DOI: 10.1186/2047-2994-1-19
PMCID: PMC3436660
PMID: 22958379
url
https://doi.org/10.1186/2047-2994-1-19View
Published (Version of record) Open Access

Abstract

BACKGROUND: Daptomycin non-susceptible enterococci (DNSE) are emerging as an important cause of healthcare-associated infection, however little is known about the epidemiology of DNSE. At the University of Iowa Hospitals and Clinics (UIHC) an increase in the frequency of patients infected and/or colonized with DNSE has occurred. The goals of this study were to evaluate potential factors associated with the development of DNSE colonization and/or infection and to compare the characteristics of patients with prior daptomycin exposure to those without prior daptomycin exposure. METHODS: The study is a retrospective case-series involving all patients with DNSE infection and/or colonization at UIHC, a 734-bed academic referral center, from June 1, 2005 to June 1, 2011. RESULTS: The majority of patients with DNSE colonization and/or infection had prior daptomycin exposure (15 of 25; 60%), a concomitant gastrointestinal process (19 of 25; 76%), or were immunosuppressed (21 of 25; 84%). DNSE infection was confirmed in 17 of 25 (68%) patients, including 9 patients with bacteremia. Twelve of 17 (71%) patients with DNSE infection had prior daptomycin exposure, including 7 of 9 (78%) patients with bacteremia. Compared to patients without prior daptomycin exposure, patients with prior daptomycin exposure were less likely to harbor E. faecalis (0% vs. 33%; p = 0.019). A high proportion of patients (10 of 25; 40%) died during their hospitalizations. Most enterococcal isolates were E. faecium (86%), and were vancomycin-resistant (72%). Molecular typing revealed a diverse population of DNSE. CONCLUSIONS: Prior daptomycin exposure, immunosuppression, and/or a concomitant gastrointestinal process, may be associated with the development of DNSE. PFGE revealed a diverse population of DNSE, which along with both increasing numbers of DNSE detected yearly and increasing annual rates of daptomycin usage, suggests the emergence of DNSE under antimicrobial pressure.

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