Oritavancin for the Treatment of Daptomycin Nonsusceptible Vancomycin-Resistant Enterococci Osteomyelitis

Vancomycin-resistant enterococci (VRE) are a growing cause of health care-associated infections globally, and limited treatment options exist for invasive VRE infections. Daptomycin is commonly used with modest success in the treatment of deep-seated infections secondary to VRE; however, there is concern for the emergence of daptomycin nonsusceptible VRE, especially during protracted courses, as required in osteomyelitis. We report the clinical and microbiologic success of a once-weekly, 6-week course of oritavancin with therapeutic drug monitoring in the treatment of daptomycin nonsusceptible VRE osteomyelitis secondary to prosthetic hip replacement. Our data suggest favorable pharmacokinetics and no treatment-related adverse events with once-weekly dosing. This report provides compelling information for future studies of prolonged oritavancin regimens in deep-seated infections.