%0 Journal Article
%T High-dose daptomycin and fosfomycin treatment of a patient with endocarditis caused by daptomycin-nonsusceptible Staphylococcus aureus: Case report
%A Liang-Yu Chen
%A Cheng-Hsiung Huang
%A Shu-Chen Kuo
%A Chen-Yuan Hsiao
%A Mei-Lin Lin
%A Fu-Der Wang
%A Chang-Phone Fung
%J BMC Infectious Diseases
%D 2011
%I BioMed Central
%R 10.1186/1471-2334-11-152
%X We describe the emergence of DNS S. aureus. in a patient with implantable cardioverter-defibrillator (ICD) device -related endocarditis who was priorily treated with daptomycin. Metastatic dissemination as osteomyelitis further complicated the management of endocarditis. The dilemma was successfully managed by surgical removal of the ICD device and combination antimicrobial therapy with high-dose daptomycin and fosfomycin.Surgical removal of intracardiac devices remains an important adjunctive measure in the treatment of endocarditis. Our case suggests that combination therapy is more favorable than single-agent therapy for infections caused by DNS S. aureus.Infective endocarditis is a clinically significant disease with mortality ranging from 16% to 25% [1,2], and Staphylococcus aureus is reported as the most common pathogen, accounting for 31.4% of cases in developing countries [3]. In addition to methicillin-resistant S. aureus (MRSA), the emergence of vancomycin-resistant S. aureus also became a major problem after the first report in Japan in 1997 [4].Daptomycin is a 13-aminoacid compound derived from fermentation of Streptomyces roseosporus and is a new treatment option for S. aureus endocarditis, including vancomycin-resistant S. aureus [5,6]. The once daily dosing of daptomycin 6 mg/kg approved by the USA Food and Drug administration showed non-inferiority to the standard therapy for treating S. aureus bacteremia and endocarditis [7]. However, increased incidence of daptomycin-nonsusceptible (DNS) S. aureus was reported recently. Mutations in the mprF and yycFG genes, related to membrane fluidity changes or fatty acid biosynthesis, were identified recently as possible contributors to daptomycin nonsusceptibility [5,8]. Effective management in case of DNS S. aureus infections is an important issue nowadays.Fosfomycin, a phosphonic acid derivative (cis-1,2-epoxypropyl phosphonic acid), was initially described and isolated in 1969 from cultures of Streptomyces
%K Daptomycin-nonsusceptible
%K fosfomycin
%K ICD device-related endocarditis
%U http://www.biomedcentral.com/1471-2334/11/152