Failure of high-dose daptomycin for bacteremia caused by daptomycin-susceptible Enterococcus faecium harboring LiaSR substitutions

Clin Infect Dis. 2014 Nov 1;59(9):1277-80. doi: 10.1093/cid/ciu642. Epub 2014 Aug 8.

Abstract

High-dose daptomycin (DAP) therapy failed in a neutropenic patient with bloodstream infection caused by a DAP-susceptible Enterococcus faecium (minimum inhibitory concentration, 3 µg/mL) harboring genetic changes associated with DAP resistance, with persistent bacteremia and selection of additional resistances. Daptomycin monotherapy should be used cautiously against DAP-susceptible E. faecium strains with minimum inhibitory concentrations >2 µg/mL.

Keywords: Enterococcus faecium; daptomycin; resistance; treatment failure.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / therapeutic use
  • Bacteremia* / drug therapy
  • Bacteremia* / microbiology
  • Chemotherapy-Induced Febrile Neutropenia
  • Daptomycin* / administration & dosage
  • Daptomycin* / therapeutic use
  • Enterococcus faecium / drug effects*
  • Enterococcus faecium / isolation & purification
  • Fatal Outcome
  • Gram-Positive Bacterial Infections* / drug therapy
  • Gram-Positive Bacterial Infections* / microbiology
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Treatment Failure
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Daptomycin