{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T13:28:57Z","timestamp":1793107737762,"version":"4.5.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background.<\/jats:title>\n                    <jats:p>Vancomycin-resistant Enterococcus bloodstream infections (VRE-BSIs) are associated with significant mortality. Daptomycin exhibits concentration-dependent activity vs VRE in vitro, yet the clinical impact of higher-dose strategies remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods.<\/jats:title>\n                    <jats:p>We performed a national retrospective cohort study of hospitalized Veterans Affairs patients treated with standard-dose (6 mg\/kg total body weight), medium-dose (8 mg\/kg total body weight), or high-dose (\u226510 mg\/kg total body weight) daptomycin for VRE-BSI. Patient-related, microbiological, and outcomes data were abstracted from clinical databases. The primary outcome was overall survival, evaluated by Cox regression. Secondary outcomes included 30-day mortality, time to microbiological clearance, and creatine phosphokinase (CPK) elevation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results.<\/jats:title>\n                    <jats:p>A total of 911 patients were included (standard dose, n = 709; medium dose, n = 142; high dose, n = 60). Compared to high-dose daptomycin, both standard-dose (hazard ratio [HR], 2.68; 95% confidence interval; [CI], 1.33\u20133.06; P = .002) and medium-dose (HR, 2.66; 95% CI, 1.33\u20133.92; P = .003) daptomycin were associated with poorer survival. After adjusting for confounders, the relationship between poorer survival and standard-dose (adjusted HR [aHR], 2.58; 95% CI, 1.27\u20134.88; P = .004) and medium-dose (aHR, 2.52; 95% CI, 1.27\u20135.00; P = .008) daptomycin persisted. Thirty-day mortality was significantly lower among high-dose daptomycin\u2013treated patients compared with other dosing strategies (risk ratio, 0.83; 95% CI, .74\u2013.94; P = .015). Compared with standard-dose daptomycin, both medium-dose (HR, 0.78; 95% CI, .55\u2013.90; P = .012) and high-dose daptomycin (HR, 0.70; 95% CI, .41\u2013.84; P = .006) were associated with significantly improved microbiological clearance. No difference in the risk of CPK elevation was observed between the treatment groups (P = .504).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions.<\/jats:title>\n                    <jats:p>High-dose daptomycin was associated with improved survival and microbiological clearance in VRE-BSI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciw815","type":"journal-article","created":{"date-parts":[[2016,12,8]],"date-time":"2016-12-08T23:05:48Z","timestamp":1481238348000},"page":"605-613","source":"Crossref","is-referenced-by-count":80,"title":["Comparative Effectiveness and Safety of Standard-, Medium-, and High-Dose Daptomycin Strategies for the Treatment of Vancomycin-Resistant Enterococcal Bacteremia Among Veterans Affairs Patients"],"prefix":"10.1093","volume":"64","author":[{"given":"Nicholas S.","family":"Britt","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Barnes-Jewish Hospital 1 , St Louis, Missouri ;"},{"name":"Research Department 2 and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M.","family":"Potter","sequence":"additional","affiliation":[{"name":"Pharmacy Service, Dwight D. Eisenhower Veterans Affairs Medical Center 3 , Leavenworth, Kansas ;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimish","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences 4 , Albany, New York ;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly E.","family":"Steed","sequence":"additional","affiliation":[{"name":"Research Department 2 and"},{"name":"Department of Pharmacy Practice, University of Kansas School of Pharmacy 5 , Lawrence"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2016,12,22]]},"reference":[{"key":"2024111411403028900_CIT0001","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1086\/421946","article-title":"Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance 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