A case of fatal daptomycin-resistant, vancomycin-resistant enterococcal infective endocarditis in end-stage kidney disease. Issue 5 (10th September 2015)

• Record Type: Journal Article
• Authors: O'Connor, Ciara; Casserly, Liam F.; Qazi, Junaid; Power, Lorraine; Finnegan, Cathriona; O'Connell, Nuala H.; Dunne, Colum P.
• Is Part Of: JMM case reports. Volume 2:Issue 5(2015)
• Publication Date: 2015-09-10
• Subjects: Daptomycin -- end-stage kidney disease (ESKD) -- resistance -- rifampicin -- vancomycin-resistant Enterococcus (VRE); Medical microbiology -- Periodicals; 616.9041
• DOI: 10.1099/jmmcr.0.000089
• Languages: English
• ISSNs: 2053-3721

Abstract

Abstract : Introduction: Ireland currently has the highest reported rate in Europe of vancomycin-resistant Enterococcus (VRE) isolated from the bloodstream, but data regarding the prevalence of VRE endocarditis remain scarce. Treatment options for Enterococcus -mediated endocarditis are limited, and therefore daptomycin is commonly used off licence in this setting. Case presentation: A 60-year-old male with end-stage kidney disease (ESKD) presented with VRE bacteraemia secondary to a gangrenous right foot colonized with vancomycin-resistant Enterococcus faecium . Aortic valve endocarditis was confirmed using transoesophageal echocardiography. Treatment was commenced with linezolid and subsequently modified to combination therapy with daptomycin and rifampicin. High-dose daptomycin therapy was employed unsuccessfully and, after 20 days of therapy, daptomycin resistance emerged, which proved fatal. Conclusion: The case was ethically challenging and involved a refusal of amputation and, ultimately, any form of treatment by the patient. In summary, however, daptomycin-resistant VRE bacteraemia complicated by recalcitrant daptomycin-resistant VRE endocarditis proved fatal for this patient. Further evaluation of the efficacy and safety of high-dose daptomycin for the treatment of VRE infective endocarditis is needed.