392 Impact of Daptomycin Minimum Inhibitory Concentration (MIC) on Outcomes of Patients with Hematologic Malignancies and Hematopoietic Stem Cell Transplant (HSCT) Recipients with Vancomycin-Resistant Enterococci (VRE) Bloodstream Infection (BSI)

Track: Poster Abstracts
Saturday, February 14, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Pearlie P. Chong, MD , Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
David van Duin, MD, PhD , Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
Ananta Bangdiwala , Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
Anastasia Ivanova, PhD , Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
Alan Kerr , Clinical Microbiology/Immunology, McLendon Clinical Laboratories, University of North Carolina Hospitals, Chapel Hill, NC
David J. Weber, MD, MPH , Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
Peter H. Gilligan, PhD , Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
Tippu Khan, PharmD , Department of Pharmacy, University of North Carolina, Chapel Hill, NC
Thomas C. Shea, MD , Bone Marrow Transplant Program, Division of Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
Presentation recording not available for download or distribution as requested by the presenting author.
Background: VRE is a common cause of BSI and daptomycin is often used as first-line therapy. The Clinical and Laboratory Standards Institute (CLSI) defines VRE isolates with daptomycin MIC (D-MIC) of ≤4 mg/L as susceptible. Clinical significance and treatment outcomes of VRE BSI episodes with D-MIC of 4, compared to those with D-MIC of 2 is currently undefined.

Patients and Methods: A single-center retrospective chart review of adults with hematologic malignancies and HSCT (autologous and allogeneic) recipients diagnosed with VRE BSI between September 2006 and September 2014 was performed. D-MICs were determined using Etest and VRE isolates with MICs <2 or >4 were excluded from the study. Only the first VRE BSI episode per patient was included.

Results: 53 BSI episodes were identified in 59 patients (27 allogeneic and 3 autologous HSCT; 29 with hematologic malignancies); of which 47.2% (25 of 53) and 52.8% (28 of 53) were due to isolates with D-MICs of 4 and 2 respectively. The median duration of bacteremia (4 versus 3 days; p = 0.20), median duration of neutropenia (15 vs. 17 days; p = 0.78), and Pitt Bacteremia Score (p = 0.51) did not differ significantly between patients with VRE BSI due to D-MICs of 4 and 2. The all-cause 30-day mortality after onset of BSI was 44.4% (D-MIC: 4) vs. 55.6% (D-MIC: 2) in HSCT recipients and 33.3% (D-MIC: 4) vs. 55.6% (D-MIC: 2) in patients with hematologic malignancies. 100% of the episodes were due to Enterococcus faecium, with central venous catheters identified as the most common source of BSI. Daptomycin monotherapy was the most common treatment choice, used in 80% (47 of 59) of the BSI episodes.

Conclusion: The all-cause 30-day mortality, duration and severity of bacteremia did not appear to be different between VRE BSI episodes with D-MICs of 4 versus 2 in HSCT recipients and patients with hematologic malignancies.

Disclosures:
D. van Duin, STERIS, receiving grant support: Research Funding
Pfizer , DSMB: DSMB
Astellas, Speaker's bureau: Speaker's bureau
Sanofi, Consultant: Consultancy

T. C. Shea, Otsuka, Research: Research Funding
Bristol Myers Squibb, Research: Research Funding
Novartis, Research: Research Funding
Millennium, Research: Research Funding
GSK, Research: Research Funding
Spectrum Pharmaceuticals, Advisory member: Advisory Board
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