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Daptomycin-resistant Enterococcus faecium in a patient with acute myeloid leukemia
Jennifer K Long1, Toni K Choueiri, Geraldine S Hall
1Department of Pharmacy, Clinical Microbiology Section, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Mayo Clinic Proceedings
|September 24, 2005
Summary
Daptomycin resistance can emerge in Enterococcus faecium infections, even in patients with acute myeloid leukemia. Linezolid effectively treated this resistant infection, highlighting its potential as an alternative therapy.
Area of Science:
- Infectious Diseases
- Hematology
- Microbiology
Background:
- Daptomycin is a key antimicrobial for gram-positive infections.
- Acute myeloid leukemia patients often face febrile neutropenia, requiring potent antibiotics.
Observation:
- A patient with acute myeloid leukemia developed a daptomycin-resistant Enterococcus faecium infection during treatment.
- This complication occurred despite daptomycin therapy for febrile neutropenia.
Findings:
- The patient's infection resolved with linezolid treatment, indicated by defervescence and negative blood cultures.
- Current guidelines lack clear breakpoints for daptomycin susceptibility testing in enterococci, complicating interpretation.
Implications:
- Daptomycin resistance in enterococci necessitates alternative treatment strategies.
- Linezolid and quinupristin-dalfopristin may serve as effective alternatives due to a lack of cross-resistance.
- Improved susceptibility testing guidelines for daptomycin in enterococci are needed.