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15 November 2007

Volume 45, Number 10
Clinical Infectious Diseases 2007;45:1343–1346
1058-4838/2007/4510-0015$15.00
DOI: 10.1086/522656
BRIEF REPORT

Failure of Daptomycin Monotherapy for Endocarditis Caused by an Enterococcus faecium Strain with Vancomycin‐Resistant and Vancomycin‐Susceptible Subpopulations and Evidence of In Vivo Loss of the vanA Gene Cluster

Cesar A. Arias,1,2,6

Harrys A. Torres,2,5

Kavindra V. Singh,1,2

Diana Panesso,6

Judson Moore,1

Audrey Wanger,4 and

Barbara E. Murray1,2,3

1Center for the Study of Emerging and Reemerging Pathogens and Departments of 2Internal Medicine, Division of Infectious Diseases, 3Microbiology and Molecular Genetics, and 4Pathology, The University of Texas Medical School, and 5Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; and 6Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia

A patient with native valve endocarditis caused by a vancomycin “heteroresistant” strain of Enterococcus faecium experienced failure of daptomycin monotherapy without evidence of daptomycin resistance. The infecting organism exhibited in vivo emergence of a vancomycin‐susceptible subpopulation lacking vanA. Treatment with a combination of high‐dose daptomycin, gentamicin, and high‐dose ampicillin cleared the infection.

Received 20 February 2007; accepted 1 August 2007; electronically published 5 October 2007.

Reprints or correspondence: Dr. Barbara E. Murray, 6431 Fannin St., Rm. 2.112 MSB, University of Texas Medical School, Houston, TX 77030 ().

Cited by

D. M. Livermore. (2008) Future directions with daptomycin. Journal of Antimicrobial Chemotherapy 62:Supplement 3, iii41-iii49
Online publication date: 1-Dec-2008.
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D. P. Levine. (2008) Clinical experience with daptomycin: bacteraemia and endocarditis. Journal of Antimicrobial Chemotherapy 62:Supplement 3, iii35-iii39
Online publication date: 1-Dec-2008.
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Cesar A Arias, Barbara E Murray. (2008) Emergence and management of drug-resistant enterococcal infections. Expert Review of Anti-infective Therapy 6:5, 637-655
Online publication date: 1-Nov-2008.
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