Daptomycin non-susceptible enterococcus

There was a time, way back in the 1990's, back before quinupristin/dalfopristin (1999), linezolid (2000) or daptomycin (2003), that we had to treat VRE with an antibiotic called chloramphenicol. You remember chloramphenicol and its association with reversible bone marrow suppression and fatal aplastic anemia. Even then, VRE developed resistance to chloramphenicol, but we didn't have many other options.

So, it was an exciting time a decade ago when we suddenly had three new treatment options for the always resistant enterococcus.  Those good times have passed us by quickly.  In a new study published in ARIC, Jeremy Storm (COI alert: an ID fellow in Dan's ID division) analyzed a case-series of daptomycin non-susceptible enterococci from a 6-year period (2005-2011) at the University of Iowa.  This is a case-series, so risk factors can't specifically be measured; however, 60% of the 25 patients had prior daptomycin exposure. I've pasted Table 3 below, so you can look at the resistance profile of the isolates. Hopefully, we won't have to dig out chloramphenicol anytime soon, but I'm brushing up on its dosing just in case.

If you need more depressing enterococcal news, you can also read about a high-prevalence (61 patients) of vanB containing E. faecium in a southwest Germany neonatal ICU.