Factors and Outcomes Associated with Daptomycin Non-Susceptible Enterococcal Infections in Solid Organ Transplant Recipients.
1Medicine, University of Alabama at Birmingham, Birmingham, AL
2Pharmacy, University of Alabama at Birmingham, Birmingham, AL
3Surgery, University of Alabama at Birmingham, Birmingham, AL.
Meeting: 2016 American Transplant Congress
Abstract number: 160
Keywords: Dosage, Infection, Outcome, Pharmacokinetics
Session Information
Date: Sunday, June 12, 2016
Session Name: Concurrent Session: Organ Transplantation in the Era of Highly Resistant Pathogens
Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
Location: Room 311
Background: Daptomycin non-susceptible enterococcal (DNSE) infections are associated with poor outcomes. Information regarding factors and outcomes of DNSE in solid organ transplant (SOT) recipients (SOTR) is limited.
Methods: A single-center retrospective review was conducted of adult SOT recipients transplanted from 1/2005 – 11/2015. All recipients with a history of post transplant DNSE infection were included. Factors examined include demographics, organ type, donor type, hospitalizations, prosthetic materials (including indwelling catheters), infection site, surgical complications, induction therapy, immunosuppression, prior daptomycin exposure, & prior dialysis. Primary outcomes were graft loss and death.
Results: DNSE was isolated in 53 SOT recipients (37 males, 16 females; mean age 49.7 + 13.7 yrs). Number of patients per isolate source were: blood (12), urine (27), wound (5), pleural (5), peritoneal (9), & other (3). Primary organ transplant was lung (10), kidney (20), liver (19), heart (3), & kidney/liver (1). Prior daptomycin exposure was identified in 45.3% (24/53). Patients with renal impairment and/or on post transplant dialysis (50.9%) received reduced daptomycin dosing. The doses were >8mg/kg (2), 6-8mg/kg (3), & <6mg/kg (19). Outcomes were: 18.9% (10/53) underwent retransplantation & 54.7% (29/53) died. Median interval from transplant to DNSE was 123 days (min 8, max 3349) & from DNSE to death was 40 days (min 2, max 1670).
Conclusion: This is the largest cohort of DNSE in SOT that has been described to date. DNSE infections are associated with poor outcomes in SOT recipients. Appropriate use of daptomycin at adequate dosing levels is recommended in this population to prevent DNSE. Further study is needed to define daptomycin pharmacokinetics in transplant patients with renal impairment who have enterococcal infection.
CITATION INFORMATION: Younan K, Lee R, McCarty T, Kunz D, Locke J, Camins B, Pappas P, Baddley J, Nellore A. Factors and Outcomes Associated with Daptomycin Non-Susceptible Enterococcal Infections in Solid Organ Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Younan K, Lee R, McCarty T, Kunz D, Locke J, Camins B, Pappas P, Baddley J, Nellore A. Factors and Outcomes Associated with Daptomycin Non-Susceptible Enterococcal Infections in Solid Organ Transplant Recipients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/factors-and-outcomes-associated-with-daptomycin-non-susceptible-enterococcal-infections-in-solid-organ-transplant-recipients/. Accessed May 20, 2019.« Back to 2016 American Transplant Congress