Daptomycine et infections sévères à entérocoques

Enterococci, part of in the intestinal microbiota, are frequently involved in healthcare-associated infections. Severe enterococcal infections, particularly due to Enterococcus faecium often resistant to penicillins, are usually treated with glycopeptides. However, the prevalence of vancomycin-resistant enterococci (VRE) is high in some countries (eg United States) and daptomycin appears as a therapeutic option of choice for the treatment of severe infections due to VRE. High doses (> 6 mg/kg) seem to be necessary but optimal dosages, in particular for strains with MICs close to the susceptibility breakpoint (4 mg/L), are still unestablished. Therapy failures due to the emergence of resistant strains under treatment as well as de novo daptomycin resistance have been described in the literature. The mechanisms underlying daptomycine resistance in enterococci are still unclear. This paper reviews the antibiotic mechanisms currently known and discusses dose regimens of daptomycin used in the treatment of infections caused by VRE.