High-dose daptomycin and fosfomycin treatment of a patient with endocarditis caused by daptomycin-nonsusceptible <it>Staphylococcus aureus</it>: Case report

• Main Authors: Hsiao Chen-Yuan, Kuo Shu-Chen, Huang Cheng-Hsiung, Chen Liang-Yu, Lin Mei-Lin, Wang Fu-Der, Fung Chang-Phone
• Format: Article
• Language: English
• Published: BMC 2011-05-01
• Series: BMC Infectious Diseases
• Subjects: Daptomycin-nonsusceptible; fosfomycin; ICD device-related endocarditis
• Online Access: http://www.biomedcentral.com/1471-2334/11/152
• ISSN: 1471-2334

<p>Abstract</p> <p>Background</p> <p>Emergence of daptomycin-nonsusceptible (DNS) <it>Staphylococcus aureus </it>is a dreadful problem in the treatment of endocarditis. Few current therapeutic agents are effective for treating infections caused by DNS <it>S. aureus</it>.</p> <p>Case presentation</p> <p>We describe the emergence of DNS <it>S. aureus</it>. 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.</p> <p>Conclusions</p> <p>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 <it>S. aureus</it>.</p>