From the Guidelines
Daptomycin is not the ideal choice for treating a UTI caused by Enterococcus faecium when there is concern for pneumonia, and linezolid 600 mg IV q12 h is recommended for pneumonia. According to the guidelines for the treatment of infections due to multidrug-resistant organisms 1, linezolid is the recommended treatment for pneumonia caused by Vancomycin-resistant Enterococci (VRE), with a duration of at least 7 days. For the UTI, the recommended treatment options include linezolid 600 mg IV q12 h or daptomycin 6-12 mg/kg IV qd, with a duration of 5-7 days 1. However, considering the concern for pneumonia, linezolid would be a better choice as it can cover both conditions. Key considerations for treatment include:
- Susceptibility testing to guide therapy, as E. faecium often has multiple drug resistances
- Source control, such as removing or replacing any urinary catheter and maintaining adequate hydration to help flush the urinary system
- Individualized treatment duration based on infection severity, source control, and initial response to therapy, with consultation from an infectious diseases specialist if necessary 1.
From the FDA Drug Label
WARNINGS AND PRECAUTIONS Eosinophilic pneumonia: Discontinue daptomycin for injection and consider treatment with systemic steroids. ( 5.3)
The patient has a concern for pneumonia while being treated with daptomycin for a UTI from Enterococcus faecium.
- Daptomycin use has been associated with Eosinophilic pneumonia, a potential side effect.
- If pneumonia is suspected, discontinue daptomycin and consider treatment with systemic steroids 2.
- It is essential to monitor the patient's condition and adjust treatment accordingly.
From the Research
Treatment of UTI caused by Enterococcus faecium with Daptomycin
- Daptomycin has been shown to be effective in treating complicated urinary tract infections (UTIs) caused by gram-positive uropathogens, including Enterococcus faecium 3.
- A case study reported the successful treatment of a UTI caused by vancomycin-resistant Enterococcus faecium with daptomycin in a renal transplant recipient 4.
- Another study found that daptomycin was effective in treating vancomycin-resistant enterococcal UTIs, with all 10 patients in the case series achieving clinical cure and microbiologic eradication 5.
Concerns for Pneumonia
- There is no direct evidence in the provided studies to suggest that daptomycin would be ineffective in treating UTI caused by Enterococcus faecium in patients with concerns for pneumonia.
- However, it is essential to note that the studies focused on the treatment of UTIs, and pneumonia was not a primary concern in these cases.
- A position paper by EUCAST discusses the use of daptomycin in the treatment of enterococcal bloodstream infections and endocarditis, but does not address pneumonia specifically 6.
Risk Factors and Mortality
- A study found that UTIs caused by Enterococcus spp. are associated with high mortality, particularly in patients with severe comorbidities, immunosuppression, and vancomycin-resistant Enterococcus faecium 7.
- The study suggests that empiric treatment of at-risk patients may be justified due to the high mortality rate associated with these infections.