Abstract
ABSTRACTWhole-genome sequencing was used to examine a persistent Enterococcus faecium bacteremia that acquired heteroresistance to three antibiotics in response to prolonged multidrug therapy. A comparison of the complete genomes before and after each change revealed the emergence of known resistance determinants for vancomycin and linezolid and suggested that a novel mutation in fabF, encoding a fatty acid synthase, was responsible for daptomycin nonsusceptibility. Plasmid recombination contributed to the progressive loss of vancomycin resistance after withdrawal of the drug.
Highlights
Multidrug-resistant (MDR) Enterococcus faecium is a common cause of nosocomial infections [1]
In 2015, a 65-year-old male was admitted to Mount Sinai Hospital (MSH) who developed an E. faecium bacteremia that spanned 3 months and two hospital stays (Fig. 1)
Automated broth microdilution testing (VITEK2) of single colonies from each isolate culture showed that E. faecium acquired resistance to vancomycin, daptomycin, and linezolid following treatment with each agent (Fig. 1)
Summary
Multidrug-resistant (MDR) Enterococcus faecium is a common cause of nosocomial infections [1]. Automated broth microdilution testing (VITEK2) of single colonies from each isolate culture showed that E. faecium acquired resistance to vancomycin (day 27), daptomycin (day 50), and linezolid (day 86) following treatment with each agent (Fig. 1). We tested four isogenic strains derived from single colonies, in duplicates, to confirm vancomycin, linezolid, and daptomycin susceptibilities (Table 1).
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