Abstract
BackgroundEmergence of daptomycin-nonsusceptible (DNS) Staphylococcus aureus is a dreadful problem in the treatment of endocarditis. Few current therapeutic agents are effective for treating infections caused by DNS S. aureus.Case presentationWe 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.ConclusionsSurgical 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.
Highlights
Emergence of daptomycin-nonsusceptible (DNS) Staphylococcus aureus is a dreadful problem 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
We present our treatment experience utilizing surgical intervention and high-dose daptomycin in combination with fosfomycin for successful treatment of a patient with implantable cardioverter-defibrillator (ICD) devicerelated endocarditis complicated with osteomyelitis caused by DNS methicillin-resistant S. aureus (MRSA)
Summary
Emergence of daptomycin-nonsusceptible (DNS) Staphylococcus aureus is a dreadful problem in the treatment of endocarditis. In a patient with implantable cardioverterdefibrillator (ICD) device -related endocarditis who was priorily treated with daptomycin. The dilemma was successfully managed by surgical removal of the ICD device and combination antimicrobial therapy with high-dose daptomycin and fosfomycin. 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 became a major problem after the first report in Japan in 1997 [4]. Effective management in case of DNS S. aureus infections is an important issue nowadays
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