A successful daptomycin and micafungin dosing strategy in veno‐venous ECMO and continuous renal replacement

What is known and objective Studies have demonstrated that ECMO leads to pharmacokinetic changes, with alterations in volume of distribution, clearance and drug sequestration by the circuit. We describe a successful dosing approach for daptomycin and micafungin for the treatment of VRE faecium bacteremia and C. glabrata fungemia in a patient receiving veno‐venous ECMO and CRRT. Case summary We report a case of a patient with ARDS on veno‐venous ECMO complicated by VRE faecium bacteremia and C. glabrata fungemia. The patient was treated with daptomycin 10 mg/kg every 24 h and micafungin 150 mg every 24 h for 14 days. Key observations included the documented bacteremia and fungemia clearance without the need for ECMO circuit exchange. What is new and conclusion This case report demonstrates successful bacteremia and fungemia clearance in an adult without the need for ECMO circuit exchange. It also highlights the need for more research to identify optimal antimicrobial dosing strategies in similar scenarios. ECMO leads to pharmacokinetic changes, yet optimal antimicrobial dosing continues to be elucidated. This case report demonstrates successful bacteremia and fungemia clearance in an adult without the need for ECMO circuit exchange.