Enterococci are a frequent cause of
nosocomial infections in gastroenterology. The increase of Enterococcus faecium
infections with development of resistance to
gentamicin and
vancomycin as well as possible
linezolid resistance require alternative
antibiotic therapies. Study data show that
daptomycin, a highly bactericidal
antibiotic is effective in enterococcal
infections. However, in Germany
daptomycin is so far only approved for the treatment of complicated skin and
soft tissue infections,
bacteremia and
infective endocarditis caused by Staphylococcus aureus. In the Department of Internal Medicine I, University Hospital Halle (Saale) from May 2 009 to April 2 010 all gastroenterological patients with evidence of invasive enterococcal
infection received intravenous
daptomycin treatment at inclusion in the European Cubicin® Outcomes Registry and Experience (EU-CORE). Gastroenterological diseases treated were necrotising
pancreatitis, infected
pancreatic pseudocysts,
abscesses, obstructive
cholangitis and
sepsis. The clinical outcome was retrospectively detected by protocol-defined criteria. A total of 13 patients (8 male, 5 female, median age 59 years) with microbiologically assured enterococcal
infections (10 × E. faecium, including 1 × VRE, 6 × E. faecalis, including double
infections) were treated with intravenous
daptomycin (6 mg per kg
body weight). In the presence of
polymicrobial infections (10 of 13 patients), an additional anti-infective
therapy was initiated according to sensitivity testing. Concomitantly a direct focus approach with stenting,
puncture or drainage was performed. The clinical cure rate was 92 % (12 of 13 patients). One patient died from a non-surgically uncontrollable
malignancy (Klatskin tumour
Bismuth IIIb). There were no adverse events. These results allow us to conclude that
antibiotic therapy with
daptomycin in invasive or bacteraemic enterococcal
infections leads to high cure rates (up to 90 % and more) when concomitant and adequate focus relief is performed. Larger clinical studies to obtain an extended drug approval are desirable.