Development of Daptomycin Susceptibility Breakpoints for Enterococcus faecium and Revision of the Breakpoints for Other Enterococcal Species by the Clinical and Laboratory Standards Institute

Michael J. Satlin, David P. Nicolau, Romney M. Humphries, Joseph L. Kuti, Shelley A. Campeau, James S. Lewis, Melvin P. Weinstein, James H. Jorgensen

Research output: Contribution to journalReview articlepeer-review

19 Scopus citations

Abstract

Daptomycin is one of the few treatment options for infections caused by enterococci that are resistant to ampicillin and vancomycin, such as vancomycin-resistant Enterococcus faecium. The emergence and clinical significance of daptomycin-resistant enterococci and evolving microbiologic, pharmacokinetic-pharmacodynamic, and clinical data indicated that the pre-2019 Clinical and Laboratory Standards Institute (CLSI) susceptible-only breakpoint of ≤4 μg/mL for daptomycin and enterococci was no longer appropriate. After analyzing data that are outlined in this article, the CLSI Subcommittee on Antimicrobial Susceptibility Testing established new breakpoints for daptomycin and enterococci. For E. faecium, a susceptible dose-dependent (SDD) breakpoint of ≤4 μg/mL was established based on an increased dosage of 8-12 mg/kg/day (≥8 μg/mL-resistant). CLSI suggests infectious diseases consultation to guide daptomycin use for the SDD category. For Enterococcus faecalis and other enterococcal species, revised breakpoints of ≤2 μg/mL-susceptible, 4 μg/mL-intermediate, and ≥8 μg/mL-resistant were established based on a standard dosage of 6 mg/kg/day.

Original languageEnglish (US)
Pages (from-to)1240-1246
Number of pages7
JournalClinical Infectious Diseases
Volume70
Issue number6
DOIs
StatePublished - Mar 3 2020

Keywords

  • breakpoints
  • CLSI
  • daptomycin
  • Enterococcus faecium

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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