A rationale for combination ampicillin and daptomycin in renal transplant patients with enterococcal infective endocarditis

Abstract

Treatment of enterococcal endocarditis in patients with history of renal transplantation is complicated. Treatment failure and/or drug toxicities are not uncommon. Treatment with ampicillin and daptomycin in a renal transplant patient has been rarely reported. Here we report a patient who was successfully treated with this novel combination.

Enterococcal Faecalis Endocarditis in Renal Transplant Patients: Our Experience with Ampicillin and Daptomycin Combination

“…Thus far, the data regarding the use of daptomycin with ampicillin in clinical practice for IE is mostly case reports. [8,29] (Table 1) However, in a rabbit model, the authors recently compared the efficacy of combination therapy of daptomycin and ampicillin versus daptomycin monotherapy. Comparison was made against developed Daptomycin Non-Susceptible (DNS) strains in an experimental Enterococcal endocarditis model.…”

“…A sixth case was a kidney transplant patient who had kept her renal function within normal range for 11 years. [6,8] In all these cases, the treatment was successful when used as a primary regimen or salvage therapy, in other words, applied after failing a prior regimen or when applied as first-line treatment from the start. In all of them, the renal function was preserved in the patient with pre-existing renal disease, or in the case of a transplanted patient, the infection was eradicated.…”

“…[7] However, when first used, the combination was met with a challenge in a kidney transplant patient in 2018. [8] Later, a retrospective study of 35 patients treated with ampicillin and daptomycin was presented at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2020. [9] This was a landmark study that spanned three countries with all subspecies of Enterococcus, including E. faecium.…”

New Approaches to Manage Infections in Transplant Recipients: Report From the 2023 GTI (Infection and Transplantation Group) Annual Meeting

“…In liver transplant recipients, such resistance was indeed associated with prior daptomycin use and increased mortality [42]. In kidney transplant recipients, combinations of daptomycin and other antibiotics have also been suggested for resistant enterococcal infections [43,44].…”