Association between daptomycin dosing and in-hospital mortality in patients with vancomycin-resistant Enterococcus faecium bloodstream infection
1
Issued Date
2025-10-01
Resource Type
eISSN
26321823
Scopus ID
2-s2.0-105018202249
Journal Title
Jac Antimicrobial Resistance
Volume
7
Issue
5
Rights Holder(s)
SCOPUS
Bibliographic Citation
Jac Antimicrobial Resistance Vol.7 No.5 (2025)
Suggested Citation
Cairns K.A., Abbott I.J., Udy A.A., Peel T.N., Lee S.J., Dooley M.J., Peleg A.Y. Association between daptomycin dosing and in-hospital mortality in patients with vancomycin-resistant Enterococcus faecium bloodstream infection. Jac Antimicrobial Resistance Vol.7 No.5 (2025). doi:10.1093/jacamr/dlaf172 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/112595
Title
Association between daptomycin dosing and in-hospital mortality in patients with vancomycin-resistant Enterococcus faecium bloodstream infection
Corresponding Author(s)
Other Contributor(s)
Abstract
Background Vancomycin-resistant Enterococcus faecium (VREfm) bloodstream infections (BSIs) pose significant management challenges with uncertainties relating to the optimal daptomycin dose for treatment. Methods A retrospective cohort study of adult patients receiving ≥3 days of definitive treatment for a first episode VREfm BSI between 2015 and 2022 was undertaken. Daptomycin doses were classified as low (≤7.9 mg/kg), medium (8.0 to 9.9 mg/kg) or high (≥10 mg/kg). We aimed to assess the association between daptomycin dose and in-hospital 30-day all-cause mortality in addition to other clinical outcomes (hospital length of stay, transfer to the ICU within 48 hours and microbiological failure). In addition, we undertook a comparative analysis of mortality and other outcomes in vanB VREfm BSIs receiving definitive daptomycin and teicoplanin treatment. Results A total of 191 patients received definitive daptomycin (n = 111) or teicoplanin (n = 80) therapy and were included in two separate analyses. Of the 111 daptomycin patients, most received high-dose daptomycin (59.5%), with 29.7% and 10.8% receiving medium and low doses, respectively. All-cause 30-day in-hospital mortality was 17.1% and there was no association between daptomycin dose groups and in-hospital 30-day mortality (log rank P = 0.369). Microbiological failure was associated with dose (P = 0.036): 33.3% in the low dose group, 12.1% for medium and 19.7% for high. No mortality difference was observed between vanB VREfm BSIs treated with daptomycin or teicoplanin [adjusted cause-specific hazard ratio 0.67 (95% CI: 0.28-1.59)]. Conclusions In this contemporary study of predominantly high daptomycin doses, there was no association between daptomycin dose and 30-day in-hospital mortality but we did observe an association with microbiological failure.