Daptomycin resistance and treatment failure following vancomycin for methicillin-resistant Staphylococcus aureus (MRSA) mitral valve acute bacterial endocarditis (ABE).

Abstract

Acute bacterial endocarditis (ABE) is most commonly due to virulent pathogens, i.e., Staphylococcus aureus. S. aureus ABE may be due to methicillin-sensitive (MSSA) or methicillin-resistant (MRSA) strains and, optimally, ABE should be treated with bactericidal antibiotics. Traditionally, vancomycin has long been used to treat MRSA ABE, but it has been shown that vancomycin may increase the staphylococcal the thickness, resulting in permeability-mediated resistance. We present a case of a 72-year-old male with mitral valve MRSA ABE refractory to daptomycin therapy following initial therapy with vancomycin. We were not able to diminish the intensity of the patient's MRSA bacteremia from his mitral valve ABE, even with high-dose (12 mg/kg day) daptomycin, presumably because of permeability-mediated resistance due to antecedent vancomycin therapy.

• Authors: B A Cunha, F M Pherez
• Journal: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (Eur J Clin Microbiol Infect Dis) Vol. 28 Issue 7 Pg. 831-3 (Jul 2009) ISSN: 1435-4373 [Electronic] Germany
• PMID: 19184141 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Vancomycin
• Daptomycin

Topics

• Aged
• Anti-Bacterial Agents (therapeutic use)
• Daptomycin (therapeutic use)
• Drug Resistance, Bacterial
• Endocarditis, Bacterial (drug therapy, microbiology)
• Humans
• Male
• Methicillin-Resistant Staphylococcus aureus (drug effects)
• Mitral Valve (microbiology)
• Staphylococcal Infections (drug therapy, microbiology)
• Treatment Failure
• Vancomycin (therapeutic use)