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

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.

Treatment options for methicillin-resistant Staphylococcus aureus (MRSA) infection: Where are we now?

“…High-dose daptomycin and fosfomycin have been used successfully in endocarditis, even for daptomycin-non-susceptible isolates [103,104]. Unfortunately, problems associated with i.v.…”

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

“…These second agents have included gentamicin (191)(192)(193)(194)(195)(196)(197)(198); rifampin (191)(192)(193)(194)(195)(196)198); ␤-lactam antibiotics (195,(199)(200)(201)(202)(203)(204), including ceftaroline (202,203); TMP-SMX (201); and linezolid (201). Clinical successes with combination therapy have also been reported with rifampin (205), TMP-SMX (206,207), fosfomycin (208,209), and ␤-lactams (210,211). Unfortunately, an RCT comparing daptomycin to daptomycin combined with gentamicin was terminated after recruiting only 24 patients (ClinicalTrials.gov registration number NCT00638157).…”

Overview on fosfomycin and its current and future clinical significance

“…Additionally, no adverse effects were reported. Chen et al [9] suggest that combination therapy consisting of high-dose daptomycin and fosfomycin is an alternative treatment option for daptomycin-nonsusceptible, methicilin-resistant S. aureus native valve endocarditis or osteomyelitis. Especially, in that these two antibacterial agents are well known for their bacteriocidal activities and effective biofilm penetration [3,11].…”

“…However, clinical studies to assess the efficacy of fosfomycin are limited [34]. Based on the fact that fosfomycin monotherapy with intravenous formulation should be prohibited due to the prompt emergence of resistance during therapy, the choice of the appropriate adjunctive antibiotic should be carefully investigated and must be individualized for each patient's condition [9,17]. In a prospective study, fosfomycin was given at 2-4 g intravenously every 6 h for 14±5.6 days, in combination with other antibiotics, to 11 adults hospitalized in an Intensive Care Unit due to carbapenem-resistant K. pneumoniae infections without definition of underlying resistance mechanisms [30].…”