Daptomycin has demonstrated antibacterial activity against several antibiotic-resistant strains, including vancomycin-resistant enterococci. A paucity of data exists concerning in vivo development of daptomycin resistance of enterococci. We describe an allogeneic bone marrow transplant patient, who was found to have vancomycin-resistant Enterococcus durans bacteremia, which subsequently developed resistance to daptomycin.

Nontuberculous mycobacteria are widely distributed in the environment and have the potential to cause a wide spectrum of infections including pulmonary, bone, soft tissue or ocular infections. They are a rare cause of endophthalmitis, a potentially devastating condition, which may be acquired through contamination of water or antiseptic solutions. Diagnosis is often delayed due to low clinical suspicion, resulting in poor clinical outcomes. Newer laboratory techniques such as real-time PCR can be used for rapid detection, identification and speciation of mycobacteria and allow for initiation of focused antibiotic therapy. We describe a case of Mycobacterium abscessus endophthalmitis that developed 30 years after traumatic loss of cornea in a patient with diabetes mellitus. Case ReportA 56-year-old woman with a history of non-insulin dependent diabetes mellitus presented to the emergency room with a 1 week history of worsening right eye pain with purulent drainage, headache, nausea and fever. Thirty years ago, she had suffered a traumatic injury to the right eye while living in India, which resulted in a blind eye. After a failed corneal transplant, she was fitted with a cosmetic lens (prosthesis) that fitted over her natural residual eye. She reported that she removed the prosthesis each night and stored it in a glass of tap water. The patient denied any prior upper respiratory infections or recent travel.On physical examination, the patient was afebrile. Examination of the eye revealed proptosis, uveal prolapse, conjunctival infection and yellowish discharge (Fig. 1). White blood cell count was 16.1610 3 ml 21, sedimentation rate was 37 mm h 21 and haemoglobin A1c was 6.8 %. Initial Gram stain of the drainage showed few polymorphonuclear cells and no organisms. Computed tomography (CT) scan of the orbits showed a 1.760.861.3 cm fluid collection with gas in the preseptal soft tissues raising concern about an abscess; multiple metallic foreign bodies were also present (Fig. 2). The right globe appeared proptotic. The patient was hospitalized and treated empirically with vancomycin and piperacillin-tazobactam, as well as trimethoprim-polymyxin ophthalmic solution.On hospital day 2, culture of the eye drainage grew few colonies of Staphylococcus aureus; piperacillin-tazobactam was discontinued. Despite treatment with vancomycin the patient continued to have persistent pain and drainage.On hospital day 5, Lowenstein-Jensen agar revealed one colony of a beaded, non-branching, Gram-positive bacillus which was Kinyoun stain positive. Initial PCR was positive for mycobacterial species. Given the speed of culture growth and PCR findings, it was felt that the organism was probably in the Mycobacterium fortuitum or M. abscessus-M. chelonae group of bacteria. Single-tube multiplex, real-time PCR testing (Richardson et al., 2009) for Mycobacterium tuberculosis complex, M. avium complex, the M. fortuitum group and the M. chelonae-M. abscessus group were performed. Results of this assay suggested M. abscessus.Antibiotics were ...

Although the predominant type of infection seen in the cystic fibrosis lung remains bacterial, fungal organisms are being isolated more frequently and are associated with a high mortality rate in lung transplant recipients. We present a case of a patient with CF with sputum cultures positive for Scedosporium apiospermum prior to a successful lung transplant. She remains without evidence of infection 18 months later following treatment with a combination of triazoles and terbinafine.

To determine if there has been an increase in Scedosporium infection at our cancer center, we compared the incidence to previously published data from our institution. A retrospective analysis of records of 12 patients with cancer with culture-proven Scedosporium infection from the last decade was performed. Types of malignancy included both hematologic disease, such as leukemia and lymphoma, and solid tumors, such as breast and lung cancer. Risk factors for Scedosporium infection include prolonged neutropenia, bronchiectasis, and immunosuppressive therapy. The mortality rate for patients with Scedosporium prolificans infection was 75%, whereas patients with Scedosporium apiospermum infection were more likely to die of their underlying malignancy than infection.