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Published Online, 18 March 2008, www.theannals.com, DOI 10.1345/aph.1K561.
 The Annals of Pharmacotherapy: Vol. 42, No. 5, pp. 722-725. DOI 10.1345/aph.1K561
© 2008 Harvey Whitney Books Company.
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Successful Treatment of Vancomycin-Resistant Enterococcus faecium Pyelonephritis with Daptomycin During Pregnancy

Katherine Shea, PharmD

at time of writing, Pharmacy Practice Resident, Department of Pharmacy, Sentara Norfolk General Hospital, Norfolk, VA; now, Infectious Diseases Pharmacy Resident, Department of Pharmacy, Clarian Health Partners, Indianapolis, IN

Esther Hilburger, PharmD

Clinical Pharmacy Coordinator/Internal Medicine/Infectious Diseases Specialist, Department of Pharmacy, Sentara Careplex Hospital, Hampton, VA

Allison Baroco, MD

Infectious Diseases Fellow, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA

Edward Oldfield, MD

Professor of Medicine, Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine, Eastern Virginia Medical School

Reprints: Dr. Shea, Clarian Health Partners, 1701 N. Senate Blvd. AG401, Indianapolis, IN 46202, fax 317/962-5274, kshea{at}clarian.org

OBJECTIVE: To report successful treatment using daptomycin for pyelonephritis associated with vancomycin-resistant Enterococcus faecium (VRE) in a 27-week pregnant woman.

CASE SUMMARY: A 20-year-old 27-week pregnant patient with a history of spina bifida, neurogenic bladder, and multiple hospitalizations for recurrent urinary tract infections (UTIs) was diagnosed with pyelonephritis. She was treated with daptomycin 260 mg (4 mg/kg) daily for 14 days on the basis of a urine culture that revealed E. faecium resistant to ampicillin, nitrofurantoin, and vancomycin. All cultures following treatment revealed no growth, and the patient as well as the neonate displayed no adverse effects.

DISCUSSION: VRE UTIs can be treated safely in pregnancy with nitrofurantoin, if the organism is susceptible. Other viable options in the treatment of VRE, including linezolid, doxycycline, and quinupristin/dalfopristin, have lower urinary concentrations, teratogenic risk, or limited findings regarding their safety in pregnancy. Daptomycin was selected in this case due to its efficacy in the treatment of VRE, high urinary concentrations, pregnancy category B, and one case report indicating its successful use in pregnancy.

CONCLUSIONS: Treatment of VRE in pregnancy can be challenging due to the teratogenicity or unknown safety of available options. The use of daptomycin in our patient enabled a successful outcome of multidrug-resistant E. faecium in a complicated pregnant patient without observed neonatal abnormalities.

Key Words: daptomycin, Enterococcus faecium pyelonephritis, pregnancy, urinary tract infection, vancomycin-resistant Enterococcus

Published Online, March 18, 2008. www.theannals.com, DOI 10.1345/aph.1K561




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