We systematically evaluated 5 methods for testing daptomycin versus 48 Enterococcus faecalis, 51 Enterococcus faecium, and 50 Staphylococcus aureus isolates using (i and ii) broth microdilution (BMD) with 50-mg/liter calcium medium supplementation (reference method) and 30-mg/liter calcium medium supplementation (BMD30 method), (iii) Etest, and (iv and v) MicroScan panel 33 using 2 methods to prepare the bacterial inoculum (MicroScan turbidity and MicroScan Prompt). Isolates were categorized as susceptible (S) or nonsusceptible (NS) based on measured MICs. Essential (؎1 dilution) agreement (EA) and categorical (S/NS) agreement (CA) for each method were compared to the reference method. For E. faecium, categorical agreement was poor between the reference method and BMD30 as well as with the three commercial methods, with frequent false-NS results (30 for BMD30, 18 for Etest, 22 for MicroScan Prompt, and 25 for MicroScan turbidity). All E. faecalis isolates were judged to be S by the reference method; two of these isolates were categorized as NS using the BMD30 method, and one was categorized as NS by all three commercial methods. All S. aureus isolates were judged to be S using all five methods. MIC values determined by the comparator methods tended to be higher than those for the reference method, especially for E. faecium isolates. EAs between the reference BMD and BMD30, Etest, MicroScan Prompt, and MicroScan turbidity were 63%, 63%, 63%, and 56%, respectively, for E. faecium, 87%, 83%, 98%, and 80%, respectively, for E. faecalis, and all 100% for S. aureus. Daptomycin is a cyclic lipopeptide with activity against Grampositive organisms. It was approved by the Food and Drug Administration initially in 2003 for the treatment of complicated skin and skin structure infections caused by Staphylococcus aureus, vancomycin-susceptible Enterococcus faecalis, and some streptococcal species. Subsequently, in 2006, it was approved for the treatment of S. aureus bacteremia and right-sided endocarditis. It is one of the few antibiotics that exhibits in vitro bactericidal activity against enterococci (1).An evaluation of daptomycin activity trends against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) during a 6-year period (2005 to 2010) in 32 U.S. medical centers showed that daptomycin exhibited sustained activity against an extensive collection of clinical isolates of MRSA and VRE from numerous U.S. medical centers over the last 6 monitored years (2). However, daptomycin-nonsusceptible (NS) enterococcal isolates have been reported and multiple mechanisms of resistance have been described (3-7).Currently, daptomycin is frequently used to treat infections caused by MRSA and VRE. In 2009, the clinical microbiology laboratory at Robert Wood Johnson University Hospital (RWJUH) (New Brunswick, NJ) began routinely testing Staphylococcus aureus and enterococci for daptomycin susceptibility using the MicroScan Pos Combo panel type 33 (PC33) MIC plate (Siemens Healthcare Diagnostics, ...
Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome in which widespread activation of the immune system causes multi-organ tissue damage. HLH is a serious and potentially fatal disorder characterized by excessive immune system activation. It is characterized by a dysregulation in natural killer (NK) T-cell function, causing activation of lymphocytes and histiocytes. These cells secrete a large number of inflammatory cytokines and infiltrate various tissues causing multi-organ system failure. The spectrum consists of hereditary or "primary" HLH that comprises genetically heterogeneous conditions, occurring during childhood. The secondary form presents later in life and is associated with several conditions mainly malignancy, autoimmune diseases, viral or bacterial infections, and hematological diseases. Here we present an interesting case in which a 39-year-old patient presented with a complaint of shortness of breath. He was diagnosed with obstructive uropathy in the emergency department and subsequently developed acute liver injury, acute kidney injury, Escherichia coli bacteremia, and was diagnosed with HLH with comorbid bacteremia.
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