Daptomycin nonsusceptible vancomycin resistant Enterococcus bloodstream infections in patients with hematological malignancies: risk factors and outcomes

Leuk Lymphoma. 2017 Dec;58(12):2852-2858. doi: 10.1080/10428194.2017.1312665. Epub 2017 Apr 12.


Daptomycin is typically the treatment of choice for vancomycin resistant Enterococcus (VRE) bloodstream infections (BSI) in patients with hematological malignancies, but increasingly daptomycin nonsusceptible VRE are being reported. We reviewed our experience with daptomycin nonsusceptible VRE BSI among patients with hematological malignancies. We compared risk factors and outcomes of 20 patients with daptomycin nonsusceptible VRE BSI (case patients) with 40 matched control patients with daptomycin susceptible VRE BSI. Case patients had more complications (6/20 vs. 2/40, p = .013); all-cause mortality was similar in both groups. By multivariable analysis, only prior daptomycin exposure within 90 days was significantly associated with daptomycin nonsusceptible VRE BSI (odds ratio 26.71; p < .0001). In 25% of case patients, all of whose VRE isolates had an initial minimum inhibitory concentration (MIC) of 4 μg/mL, nonsusceptibility developed during treatment, raising the question of whether higher doses of daptomycin should be used for VRE BSI in hematology patients.

Keywords: Vancomycin resistant Enterococcus; daptomycin; daptomycin nonsuceptible enterococci; hematological malignancy; hematopoietic cell transplant.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia*
  • Case-Control Studies
  • Daptomycin / pharmacology*
  • Daptomycin / therapeutic use
  • Female
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / epidemiology*
  • Gram-Positive Bacterial Infections / etiology*
  • Gram-Positive Bacterial Infections / mortality
  • Hematologic Neoplasms / complications*
  • Hematologic Neoplasms / epidemiology*
  • Hematologic Neoplasms / mortality
  • Humans
  • Linezolid / pharmacology
  • Linezolid / therapeutic use
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Risk Factors
  • Treatment Outcome
  • Vancomycin-Resistant Enterococci / drug effects*


  • Anti-Bacterial Agents
  • Linezolid
  • Daptomycin