|Year : 2016 | Volume
| Issue : 3 | Page : 398-399
Daptomycin: A viable therapeutic option for vancomycin-resistant enterococcal urinary-tract infections in Indian medical settings?
B Mohan, S Garg, SB Appannanavar, N Taneja
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Submission||10-Apr-2015|
|Date of Acceptance||23-Oct-2015|
|Date of Web Publication||12-Aug-2016|
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mohan B, Garg S, Appannanavar S B, Taneja N. Daptomycin: A viable therapeutic option for vancomycin-resistant enterococcal urinary-tract infections in Indian medical settings?. Indian J Med Microbiol 2016;34:398-9
|How to cite this URL:|
Mohan B, Garg S, Appannanavar S B, Taneja N. Daptomycin: A viable therapeutic option for vancomycin-resistant enterococcal urinary-tract infections in Indian medical settings?. Indian J Med Microbiol [serial online] 2016 [cited 2020 Feb 21];34:398-9. Available from: http://www.ijmm.org/text.asp?2016/34/3/398/188377
A global upsurge has been reported in the prevalence of vancomycin-resistant enterococcal urinary-tract infections (VRE-UTIs) with adverse clinical outcomes.  The proportion of nosocomial UTIs due to VRE increased 5-fold from 5.56% to 27.86% (P < 0.0001) in our institute as well (unpublished data). VRE are often resistant to multiple anti-microbial drugs such as ciprofloxacin, amoxicillin and gentamicin that are commonly used to treat UTI. Teicoplanin, linezolid, quinpristin-dalfopristin, etc., are optional compounds, usually reserved for the treatment of upper and/or bacteremic VRE-UTI; however, these agents have their own limitations.  Since usage of daptomycin, a lipopeptide antibiotic is rare in tertiary care centres. The reported cases of daptomycin non-susceptibility are expected to be low; and therefore, daptomycin may be a viable therapeutic option for VRE-UTI in Indian medical settings. Daptomycin is a concentration-dependent bactericidal agent, given in once daily dosage,  has fewer side effects, less drug interactions and no cross-resistance with other classes of antimicrobial agents.  Daptomycin was found to be active against 99.5% of Enterococcus faecium and 100% Enterococcus faecalis in surveys conducted on non-urinary enterococci across 27 medical centres of the United States in 2007-2008.  However, data on the daptomycin resistance in VRE causing UTI are scarce. This study was conducted in the Enteric Laboratory of the Department of Medical Microbiology, at PGIMER, Chandigarh, on 140 non-repetitive urinary isolates of enterococci recovered prospectively from hospitalised patients with UTI from January 2013 to June 2013. Strains were identified by conventional biochemical reactions;  screened for vancomycin, teicoplanin and daptomycin susceptibility by E-test (bioMérieux, New Delhi, India) and tested by Kirby-Bauer disc diffusion method for susceptibility to amoxicillin (10 μg), high level gentamicin (120 μg), ciprofloxacin (5 μg), tetracycline (30 μg), nitrofurantoin (300 μg), vancomycin (30 μg), teicoplanin (30 μg) and linezolid (30 μg). On speciation, majority of isolates were E. faecium (72.2%) followed by E. faecalis (24.3%). On comparing E. faecium with E. faecalis, there was a significant difference in resistance rates for amoxicillin and high-level gentamicin (P < 0.05) [Table 1]. Resistance to vancomycin was 1.9-fold higher in E. faecium than E. faecalis strains. All E. faecalis strains were susceptible to daptomycin; however, 83.65% of E. faecium strains demonstrated resistance. Vancomycin-sensitive enterococcal (VSE) and VRE strains showed MIC 50 of 2 mg/L and 4 mg/L, respectively, for daptomycin whereas MIC 90 for VSE isolates was determined to be 4 mg/L while that for VRE isolates was 32 mg/L. Of 17 daptomycin non-susceptible enterococci, 6 were non-susceptible/intermediately susceptible to vancomycin (4 had MIC >256 mg/L, 2 isolates with MIC 8 mg/L), and rest 11 isolates were VSE. Linezolid expressed excellent activity (100%) against all enterococcal isolates irrespective of species or vancomycin sensitivity. We also noted that 76.92% (30/39) strains of VRE were susceptible to nitrofurantoin. Though a good agent for uncomplicated UTI, nitrofurantoin should be used with caution in patients with decreased creatinine clearance (<60 ml/min) due to the risk of peripheral neuropathy. It is also not useful for bacteremic/complicated/upper UTI, unlike daptomycin.  In conclusion, daptomycin shows excellent in-vitro activity against E. faecalis. However, 16.35% of E. faecium were found to be non-susceptible to daptomycin; therefore, more clinical and microbiological data is required to elucidate the role of daptomycin to treat UTI caused by VRE. To the best of our knowledge, this is a first report of daptomycin-resistant enterococci from India.
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Conflicts of interest
There are no conflicts of interest.
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