Failure of Daptomycin Monotherapy for Endocarditis Caused by an Enterococcus faecium Strain with Vancomycin-Resistant and Vancomycin-Susceptible Subpopulations and Evidence of In Vivo Loss of the vanA Gene Cluster

A patient with native valve endocarditis caused by a vancomycin "heteroresistant" strain of Enterococcus faecium experienced failure of daptomycin monotherapy without evidence of daptomycin resistance. The infecting organism exhibited in vivo emergence of a vancomycin-susceptible subpopula...

Full description

Saved in:
Bibliographic Details
Published in:Clinical infectious diseases 2007-11, Vol.45 (10), p.1343-1346
Main Authors: Arias, Cesar A., Torres, Harrys A., Singh, Kavindra V., Panesso, Diana, Moore, Judson, Wanger, Audrey, Murray, Barbara E.
Format: Article
Language:English
Subjects:
Ampicillin - therapeutic use
Anti-Bacterial Agents - therapeutic use
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Bacteremia
Bacterial Proteins - genetics
Biological and medical sciences
Blood
Brief Reports
Carbon-Oxygen Ligases - genetics
Cardiology. Vascular system
Daptomycin - therapeutic use
DNA, Bacterial - genetics
Drug Therapy, Combination
Endocardial and cardiac valvular diseases
Endocarditis
Endocarditis, Bacterial - drug therapy
Endocarditis, Bacterial - microbiology
Enterococcus faecium
Enterococcus faecium - drug effects
Enterococcus faecium - genetics
Enterococcus faecium - isolation & purification
Genetic hybridization
Gentamicins - therapeutic use
Gram-Positive Bacterial Infections - drug therapy
Gram-Positive Bacterial Infections - microbiology
Heart
Heart valves
Humans
Infections
Infectious diseases
Male
Medical sciences
Microbial Sensitivity Tests
Middle Aged
Multigene Family
Pharmacology. Drug treatments
Treatment Failure
Vancomycin resistance
Vancomycin Resistance - genetics
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:A patient with native valve endocarditis caused by a vancomycin "heteroresistant" strain of Enterococcus faecium experienced failure of daptomycin monotherapy without evidence of daptomycin resistance. The infecting organism exhibited in vivo emergence of a vancomycin-susceptible subpopulation lacking vanA. Treatment with a combination of high-dose daptomycin, gentamicin, and high-dose ampicillin cleared the infection.
ISSN:1058-4838
1537-6591
DOI:10.1086/522656