Daptomycin
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Development of daptomycin resistance in Corynebacterium striatum endocarditis: case report A 56-year-old man developed native valve endocarditis caused by Corynebacterium striatum, which was resistant to daptomycin [time to reaction onset not clearly stated]. He later died. The man was transferred to a hospital with a 1-week history of lethargy, fever and dyspnoea. During the previous year, he had received two 6-week courses of daptomycin 6 mg/kg [routes not stated] for catheter-related bloodstream infection and osteomyelitis caused by methicillin-resistant Staphylococcus aureus. He had completed the last course 3 weeks prior to the current admission. He had received IV daptomycin 6 mg/kg every 48 hours upon admission to the first hospital, but had been transferred after not responding to treatment. On evaluation, he had tachycardia, anaemia and leucocytosis. Echocardiogram showed a vegetation with abscess formation on the posterior leaflet of the mitral valve with severe mitral regurgitation. Bilateral lung infiltrates and bilateral thalamic and posterior occipital lobe infarctions were also apparent. Corynebacterium spp. bacteria was isolated from blood culture; two subpopulations displaying daptomycin susceptibility and high-level resistance to daptomycin were found, with minimum inhibitory concentrations of ≤0.094 and ≥256 µg/mL, respectively. Daptomycin was replaced with telavancin. Repeat blood cultures were negative and mitral valve replacement was performed. The man was discharged on telavancin following an uneventful postoperative course. He was readmitted 3 weeks later with severe sepsis, candidaemia and multiorgan failure. Blood cultures remained negative for bacteria, but he died due to complications of sepsis. Author comment: "[I]t is very plausible that the use of prolonged courses of daptomycin may also exert pressure on the Gram-positive skin commensal flora and select for high daptomycin resistance in organisms such as Corynebacterium spp. with the potential of causing severe disease, such as IE. . . The history of daptomycin therapy strongly suggests that resistance was selected upon exposure to daptomycin . . ." Tran TT, et al. Native valve endocarditis caused by Corynebacterium striatum with heterogeneous high-level daptomycin resistance: Collateral damage from daptomycin therapy?. Antimicrobial Agents and Chemotherapy 56: 3461-3464, No. 6, Jun 2012. Available from: URL: http://dx.doi.org/10.1128/AAC.00046-12 803074175 USA
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Reactions 28 Jul 2012 No. 1412
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