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CORRESPONDENCE
Year : 2016  |  Volume : 34  |  Issue : 3  |  Page : 398-399
 

Daptomycin: A viable therapeutic option for vancomycin-resistant enterococcal urinary-tract infections in Indian medical settings?


Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission10-Apr-2015
Date of Acceptance23-Oct-2015
Date of Web Publication12-Aug-2016

Correspondence Address:
N Taneja
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.188377

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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


Dear Editor,

A global upsurge has been reported in the prevalence of vancomycin-resistant enterococcal urinary-tract infections (VRE-UTIs) with adverse clinical outcomes. [1] 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 0.0001) in our institute as well (unpublished data).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. [1] 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, [2] has fewer side effects, less drug interactions and no cross-resistance with other classes of antimicrobial agents. [3] 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. [4] 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; [5] 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. [1] 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.
Table 1: Antimicrobial RR of E. faecalis and E. faecium strains


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 ~ References Top

1.
Heintz BH, Halilovic J, Christensen CL. Vancomycin-resistant enterococcal urinary tract infections. Pharmacotherapy 2010;30:1136-49.  Back to cited text no. 1
    
2.
Rybak MJ, Hershberger E, Moldovan T, Grucz RG. In vitro activities of daptomycin, vancomycin, linezolid, and quinupristin-dalfopristin against Staphylococci and Enterococci, including vancomycin- intermediate and -resistant strains. Antimicrob Agents Chemother 2000;44:1062-6.  Back to cited text no. 2
    
3.
Ramaswamy DP, Amodio-Groton M, Scholand SJ. Use of daptomycin in the treatment of vancomycin-resistant enterococcal urinary tract infections: A short case series. BMC Urol 2013;13:33.  Back to cited text no. 3
    
4.
Sader HS, Jones RN. Antimicrobial susceptibility of Gram-positive bacteria isolated from US medical centers: Results of the Daptomycin Surveillance Program (2007-2008). Diagn Microbiol Infect Dis 2009;65:158-62.  Back to cited text no. 4
    
5.
Murray BE. The life and times of the Enterococcus. Clin Microbiol Rev 1990;3:46-65.  Back to cited text no. 5
    



 
 
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