Daptomycin Resistance in Prosthetic Joint Infections

Abstract

Antimicrobial resistance has been problematic since the advent of antibiotics. Patients with prosthetic joint infections often require prolonged courses of antibiotic therapy, with resistance commonly being the consequence. The rapid evolution of resistance poses a serious challenge in the treatment of infections and creates a need for new agents with novel mechanisms of bactericidal activity. Daptomycin, a cyclic lipopeptide naturally produced by Streptomyces roseosporus, is a newer agent approved for use in complicated skin, soft tissue, and prosthetic joint infections. To our knowledge, this article describes the first case of daptomycin-resistant heterogenous vancomycin intermediate-resistant Staphylococcus aureus (hVISA) in an 82-year-old man undergoing elective total knee arthroplasty in Queensland, Australia, with a subsequent deep prosthetic joint infection.A literature review is presented, and the increasing number of multi-resistant organisms and their implications for orthopedics are discussed. Worldwide reports of hVISA are reviewed. To our knowledge, this is the first article to describe daptomycin resistance in prosthetic joint infections. The role of newer antimicrobial agents, such as daptomycin, and strategies to minimize antibiotic resistance are examined.

Novel Formulations for Antimicrobial Peptides

“…Dpt is approved in the US, Europe and Canada for treating infections by Gram-positive bacteria [71,72,73,74,75]. However, there are several reports of bacterial resistance against Dpt [76,77,78,79,80] with excellent reviews on Dpt resistance available [67,81] and also some reports on resistance against others lipodepsipeptides [82]. …”

Cyclic Lipodepsipeptides: A New Class of Antibacterial Agents in the Battle Against Resistant Bacteria

“…It is inevitable that resistant strains of bacteria will emerge in response to widespread use of antibiotics. For example, clinical isolates of S. aureus and enterococci with a loss of daptomycin susceptibility have already being reported [19,20,137]. These examples of daptomycin-resistant pathogens additionally emphasize a continuous need for the discovery and development of new antibacterial drugs with novel modes of action.…”

“…Daptomycin is also approved in the USA for the treatment of S. aureus bloodstream infections (bacteremia), including right-sided infective endocarditis. Unfortunately, staphylococcal and enterococcal clinical isolates with a loss of daptomycin susceptibility in vitro have already been reported [19–21]. Even more alarming is the observed cross-resistance between daptomycin and vancomycin in S. aureus [22–24].…”

Antibiotic-free antimicrobial poly (methyl methacrylate) bone cements: A state-of-the-art review

“…This need has served as the driver for the large amount of research attention that has been given to this field. These efforts may be grouped into four approaches: application of an antimicrobial coating to part(s) of implant component(s), such as the proximal zone of the femoral stem of a THA[ 4 , 40 - 45 ]; use of ALBCs in which a relatively new antibiotic/antibacterial compound (for example, daptomycin[ 46 ] or a second-generation lipophosphonoxin[ 47 ]) is added to the cement powder; modification of the surface of the implant (for example, incorporation of an antibiotic-releasing polymer into the surface of a joint implant[ 48 ] and use of a nanofabrication method to create biomimetically-inspired nanostructures on an implant surface[ 49 ]); and proposed use of antibiotic-free antimicrobial PMMA bone cements (AFAMBCs)[ 50 - 68 ]. The focus of the present review is AFAMBCs, which have been the subject of many studies on their formulation and characterization[ 50 - 68 ].…”