Daptomycin-resistant Enteroccoccus faecium in a patient with no prior exposure to daptomycin

De Novo Daptomycin-Nonsusceptible Enterococcal Infections

“…Two existing studies of de novo development of daptomycin nonsusceptibility describe 1 case each ( 6 , 7 ). To our knowledge, this study analyzes one of the largest series of DNSE isolates in patients with no prior exposure to daptomycin.…”

Vancomycin-Resistant Enterococci

“…2 Of note, mutations associated with DAP resistance have been described in isolates from patients who had never been exposed to DAP, and it is postulated that, in addition to spread from other patients, naturally occurring antimicrobial peptides (like those produced by the innate immune system) may trigger cell envelope adaptive responses similar to those observed with DAP. 74,75 The yycFG operon is involved in cell wall homeostasis and is highly conserved among the low G 1 C gram-positive bacteria. The yycFG operon is known to be active in modification of peptidoglycan synthesis, modulating autolysin expression (including pcsB in streptococci), and mutations in this operon are found in vancomycin-intermediate S aureus and in vancomycin-resistant S aureus strains.…”

A potential role for daptomycin in enterococcal infections: what is the evidence?

“…93 However, the study did not investigate the potential mechanisms underlying the reduced susceptibility of daptomycin. Treatment failures of enterococcal infections associated with reduced daptomycin susceptibility have been reported (Table 4), 94–100 including five cases of bacteraemia 94,95,98–100 and two cases of endocarditis. 96,97 The majority of these infections were due to VRE.…”