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Clinical Therapeutics

Impact of an Antimicrobial Stewardship Intervention on Within- and Between-Patient Daptomycin Resistance Evolution in Vancomycin-Resistant Enterococcus faecium

Clare L. Kinnear, Twisha S. Patel, Carol L. Young, Vincent Marshall, Duane W. Newton, Andrew F. Read, Robert J. Woods
Clare L. Kinnear
aDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Twisha S. Patel
bDepartment of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
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Carol L. Young
cDepartment of Pathology, University of Michigan, Ann Arbor, Michigan, USA
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Vincent Marshall
bDepartment of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
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Duane W. Newton
cDepartment of Pathology, University of Michigan, Ann Arbor, Michigan, USA
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Andrew F. Read
dDepartment of Biology, Pennsylvania State University, University Park, Pennsylvania, USA
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Robert J. Woods
aDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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DOI: 10.1128/AAC.01800-18
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ABSTRACT

Vancomycin-resistant Enterococcus (VRE) is a leading cause of hospital-acquired infection, with limited treatment options. Resistance to one of the few remaining drugs, daptomycin, is a growing clinical problem and has previously been described in this hospital. In response to increasing resistance, an antimicrobial stewardship intervention was implemented to reduce hospital-wide use of daptomycin. To assess the impact of the intervention, daptomycin prescribing patterns and clinically reported culture results from vancomycin-resistant Enterococcus faecium (VREfm) bloodstream infections (BSIs) from 2011 through 2017 were retrospectively extracted and the impact of the intervention was estimated using interrupted time series analysis (ITS). We corrected for a change in MIC determination methodology by retesting 262 isolates using Etest and broth microdilution. Hospital-wide and within-patient resistance patterns of corrected daptomycin MICs are reported. Our data show that daptomycin prescriptions decreased from an average of 287 days of therapy/month preintervention to 151 days of therapy/month postintervention. Concurrently, the proportion of patients experiencing an increase in daptomycin MIC during an infection declined from 14.6% (7/48 patients) in 2014 to 1.9% (1/54 patients) in 2017. Hospital-wide resistance to daptomycin also decreased in the postintervention period, but this was not maintained. This study shows that an antimicrobial stewardship-guided intervention reduced daptomycin use and improved individual level outcomes but had only transient impact on the hospital-level trend.

FOOTNOTES

    • Received 26 August 2018.
    • Returned for modification 27 September 2018.
    • Accepted 17 January 2019.
    • Accepted manuscript posted online 4 February 2019.
  • Supplemental material for this article may be found at https://doi.org/10.1128/AAC.01800-18.

  • Copyright © 2019 American Society for Microbiology.

All Rights Reserved.

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Impact of an Antimicrobial Stewardship Intervention on Within- and Between-Patient Daptomycin Resistance Evolution in Vancomycin-Resistant Enterococcus faecium
Clare L. Kinnear, Twisha S. Patel, Carol L. Young, Vincent Marshall, Duane W. Newton, Andrew F. Read, Robert J. Woods
Antimicrobial Agents and Chemotherapy Mar 2019, 63 (4) e01800-18; DOI: 10.1128/AAC.01800-18

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Impact of an Antimicrobial Stewardship Intervention on Within- and Between-Patient Daptomycin Resistance Evolution in Vancomycin-Resistant Enterococcus faecium
Clare L. Kinnear, Twisha S. Patel, Carol L. Young, Vincent Marshall, Duane W. Newton, Andrew F. Read, Robert J. Woods
Antimicrobial Agents and Chemotherapy Mar 2019, 63 (4) e01800-18; DOI: 10.1128/AAC.01800-18
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KEYWORDS

Enterococcus
antimicrobial resistance
antimicrobial stewardship
daptomycin
evolution

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