A novel way of treating multidrug-resistant enterococci

Persistent Link:
http://hdl.handle.net/10150/617401
Title:
A novel way of treating multidrug-resistant enterococci
Author:
Desai, Hem; Wong, Ryan; Ahmed, Khurshid Pasha
Affiliation:
Univ Arizona, Coll Med, Dept Internal Med
Issue Date:
2016
Publisher:
MEDKNOW PUBLICATIONS & MEDIA PVT LTD
Citation:
A novel way of treating multidrug-resistant enterococci 2016, 8 (5):229 North American Journal of Medical Sciences
Journal:
North American Journal of Medical Sciences
Rights:
© 2016 North American Journal of Medical Sciences. This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License.
Collection Information:
This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
Abstract:
Context: Daptomycin is the only antibiotic available with in vitro bactericidal activity against vancomycin-resistant enterococci (VRE). Its increased use has resulted in cases of decreased daptomycin efficacy. Recent in vitro studies have shown effective use of beta (beta)-lactam and daptomycin antibiotics, as a combination therapy, in the treatment of VRE. We describe a case of effective treatment in a patient with VRE infection using dual ampicillin and daptomycin therapy that shows bench-to-bedside application of the abovementioned finding. Case Report: A 76-year-old gentleman with a history of bilateral arthroplasty was admitted with a swollen left knee. Blood cultures were positive for Enterococcus faecium. Left knee joint aspiration showed leukocytosis and alpha defensins. Extensive imaging did not show any other source of infection. Culture sensitivity results showed multidrug-resistant enterococci sensitive to daptomycin. The patient was started on intravenous (IV) daptomycin. His left knee prosthesis was explanted and a spacer was placed. The patient continued to be bacteremic for 10 days after removing the knee prosthesis. The patient was trialed on combination IV ampicillin and daptomycin. His blood culture turned negative 2 days later. The patient was discharged home to continue 6 weeks of IV ampicillin and daptomycin. Conclusion: The exact mechanism of the daptomycin/ampicillin synergy effect is unclear. Current hypothesis suggests that ampicillin causes a reduction in the net positive charge of the bacterial surface, possibly by releasing lipoteichoic acid (LTA) from the cell wall. This process increases the ability of the cationic daptomycin/calcium complex to bind to the cell wall more effectively. Our case shows the clinical application of the same. A prospective randomized control trial to explore the effectiveness of dual antibiotic therapy in vivo is needed. If proven, daptomycin/-lactam can become a standard of care to treat VRE and decrease daptomycin nonsusceptibility.
Note:
Open access.
ISSN:
1947-2714
DOI:
10.4103/1947-2714.183015
Keywords:
Daptomycin; beta (beta)-lactam; daptomycin nonsusceptibility; vancomycin-resistant enterococci
Version:
Final published version
Additional Links:
http://www.najms.org/text.asp?2016/8/5/229/183015

Full metadata record

DC FieldValue Language
dc.contributor.authorDesai, Hemen
dc.contributor.authorWong, Ryanen
dc.contributor.authorAhmed, Khurshid Pashaen
dc.date.accessioned2016-07-23T00:12:25Z-
dc.date.available2016-07-23T00:12:25Z-
dc.date.issued2016-
dc.identifier.citationA novel way of treating multidrug-resistant enterococci 2016, 8 (5):229 North American Journal of Medical Sciencesen
dc.identifier.issn1947-2714-
dc.identifier.doi10.4103/1947-2714.183015-
dc.identifier.urihttp://hdl.handle.net/10150/617401-
dc.description.abstractContext: Daptomycin is the only antibiotic available with in vitro bactericidal activity against vancomycin-resistant enterococci (VRE). Its increased use has resulted in cases of decreased daptomycin efficacy. Recent in vitro studies have shown effective use of beta (beta)-lactam and daptomycin antibiotics, as a combination therapy, in the treatment of VRE. We describe a case of effective treatment in a patient with VRE infection using dual ampicillin and daptomycin therapy that shows bench-to-bedside application of the abovementioned finding. Case Report: A 76-year-old gentleman with a history of bilateral arthroplasty was admitted with a swollen left knee. Blood cultures were positive for Enterococcus faecium. Left knee joint aspiration showed leukocytosis and alpha defensins. Extensive imaging did not show any other source of infection. Culture sensitivity results showed multidrug-resistant enterococci sensitive to daptomycin. The patient was started on intravenous (IV) daptomycin. His left knee prosthesis was explanted and a spacer was placed. The patient continued to be bacteremic for 10 days after removing the knee prosthesis. The patient was trialed on combination IV ampicillin and daptomycin. His blood culture turned negative 2 days later. The patient was discharged home to continue 6 weeks of IV ampicillin and daptomycin. Conclusion: The exact mechanism of the daptomycin/ampicillin synergy effect is unclear. Current hypothesis suggests that ampicillin causes a reduction in the net positive charge of the bacterial surface, possibly by releasing lipoteichoic acid (LTA) from the cell wall. This process increases the ability of the cationic daptomycin/calcium complex to bind to the cell wall more effectively. Our case shows the clinical application of the same. A prospective randomized control trial to explore the effectiveness of dual antibiotic therapy in vivo is needed. If proven, daptomycin/-lactam can become a standard of care to treat VRE and decrease daptomycin nonsusceptibility.en
dc.language.isoenen
dc.publisherMEDKNOW PUBLICATIONS & MEDIA PVT LTDen
dc.relation.urlhttp://www.najms.org/text.asp?2016/8/5/229/183015en
dc.rights© 2016 North American Journal of Medical Sciences. This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License.en
dc.subjectDaptomycinen
dc.subjectbeta (beta)-lactamen
dc.subjectdaptomycin nonsusceptibilityen
dc.subjectvancomycin-resistant enterococcien
dc.titleA novel way of treating multidrug-resistant enterococcien
dc.typeArticleen
dc.contributor.departmentUniv Arizona, Coll Med, Dept Internal Meden
dc.identifier.journalNorth American Journal of Medical Sciencesen
dc.description.noteOpen access.en
dc.description.collectioninformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.en
dc.eprint.versionFinal published versionen
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