Abstract
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.
Publication types
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Case Reports
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Research Support, N.I.H., Extramural
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Research Support, Non-U.S. Gov't
MeSH terms
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Ampicillin / therapeutic use
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Anti-Bacterial Agents / therapeutic use
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Bacterial Proteins / genetics
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Carbon-Oxygen Ligases / genetics
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DNA, Bacterial / genetics
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Daptomycin / therapeutic use*
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Drug Therapy, Combination
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Endocarditis, Bacterial / drug therapy*
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Endocarditis, Bacterial / microbiology*
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Enterococcus faecium / drug effects*
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Enterococcus faecium / genetics
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Enterococcus faecium / isolation & purification
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Gentamicins / therapeutic use
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Gram-Positive Bacterial Infections / drug therapy*
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Gram-Positive Bacterial Infections / microbiology*
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Humans
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Male
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Microbial Sensitivity Tests
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Middle Aged
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Multigene Family
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Treatment Failure
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Vancomycin Resistance / genetics*
Substances
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Anti-Bacterial Agents
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Bacterial Proteins
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DNA, Bacterial
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Gentamicins
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VanA ligase, Bacteria
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Ampicillin
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Carbon-Oxygen Ligases
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Daptomycin