YU-CHUNG CHUANGLi H.-Y.PAO-YU CHENLin C.-Y.JANN-TAY WANGYEE-CHUN CHENSHAN-CHWEN CHANG2020-12-292020-12-2920171058-4838https://www.scopus.com/inward/record.uri?eid=2-s2.0-85021308337&doi=10.1093%2fcid%2fcix024&partnerID=40&md5=b192fe8854f11a74be41bab10908729ahttps://scholars.lib.ntu.edu.tw/handle/123456789/535164Background. Treatment options for vancomycin-resistant enterococci (VRE) bloodstream infection (BSI) are limited. Daptomycin, although not currently approved for this indication, is frequently used for the treatment of VRE-BSI. Its optimal dose still needs to be determined. Methods. We conducted a prospective, observational, cohort study during 2010-2015. We included patients who received a daptomycin dose of ?6 mg/kg for the treatment of VRE-BSI caused by daptomycin-susceptible VRE. The primary endpoint was 14-day mortality, and multivariable logistic regression was performed for outcome analysis. Results. We included 112 patients treated with daptomycin for VRE-BSI and with evaluable clinical outcomes. The daptomycin minimum inhibitory concentration (MIC) was 4 mg/L in 78 (69.6%) and ?2 mg/L in 34 (30.4%) isolates. The overall mortality was 40/112 (35.7%). The unadjusted mortality was 18/36 (50.0%) for a daptomycin dose of <7 mg/kg, 17/51 (33.3%) for a dose of 7-9 mg/kg, and 5/25 (20%) for a dose of ?9 mg/kg (P = .05). The best outcomes were associated with a daptomycin dose of ?9 mg/kg compared to doses of <7 mg/kg (adjusted odds ratio [aOR], 10.57; 95% confidence interval [CI], 2.25-49.62; P=.003) and 7-9 mg/kg (aOR, 5.01; 95% CI, 1.14-21.98; P=.03). There was no significant difference in mortality with respect to the daptomycin MIC. There was no association between daptomycin dose and elevated creatinine kinase. Conclusion. Higher daptomycin doses (?9 mg/kg) were associated with lower mortality in patients with VRE-BSI. Our results suggest that higher daptomycin doses need to be considered for VRE-BSI treatment. ? The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.[SDGs]SDG3beta lactam antibiotic; corticosteroid; creatine kinase; daptomycin; vancomycin; antiinfective agent; daptomycin; abdominal infection; adult; aged; antibiotic sensitivity; antibiotic therapy; Article; bacteremia; bloodstream infection; catheter infection; clinical outcome; cohort analysis; creatinine clearance; disease severity; drug dose comparison; drug use; Enterococcus faecium bacteremia; Enterococcus faecium bacteremia; female; human; leukocyte count; major clinical study; male; minimum inhibitory concentration; mortality; neutropenia; nonhuman; observational study; priority journal; prospective study; surgical infection; survivor; thrombocyte count; thrombocytopenia; urinary tract infection; vancomycin resistant Enterococcus; bacteremia; drug effects; Enterococcus faecium; Gram-Positive Bacterial Infections; isolation and purification; microbial sensitivity test; microbiology; middle aged; survival analysis; treatment outcome; vancomycin resistant Enterococcus; very elderly; young adult; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Daptomycin; Enterococcus faecium; Female; Gram-Positive Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Survival Analysis; Treatment Outcome; Vancomycin-Resistant Enterococci; Young Adultjournal article10.1093/cid/cix02428329222