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Clin Infect Dis. 2007 Nov 15;45(10):1343-6. Epub 2007 Oct 5.

Failure of daptomycin monotherapy for endocarditis caused by an Enterococcus faecium strain with vancomycin-resistant and vancomycin-susceptible subpopulations and evidence of in vivo loss of the vanA gene cluster.

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Center for the Study of Emerging and Reemerging Pathogens, Division of Infectious Diseases, The University of Texas Medical School, Houston, TX 77030, USA.


A patient with native valve endocarditis caused by a vancomycin "heteroresistant" strain of Enterococcus faecium experienced failure of daptomycin monotherapy without evidence of daptomycin resistance. The infecting organism exhibited in vivo emergence of a vancomycin-susceptible subpopulation lacking vanA. Treatment with a combination of high-dose daptomycin, gentamicin, and high-dose ampicillin cleared the infection.

[Indexed for MEDLINE]

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