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Multidrug-resistant Enterococcus faecium endocarditis treated with combination tigecycline and high-dose daptomycin
Amanda C Schutt1, Nicole M Bohm
1College of Pharmacy Residency Program, Medical University of South Carolina, Charleston, SC 29425, USA.
The Annals of Pharmacotherapy
|November 6, 2009
Summary
This case study highlights a multidrug-resistant Enterococcus faecium infection. Combination therapy with tigecycline and daptomycin proved effective when other treatments failed, showing potential for difficult-to-treat endocarditis.
Area of Science:
- Infectious Diseases
- Pharmacology
- Cardiology
Background:
- Multidrug-resistant Enterococcus faecium poses a significant challenge in clinical settings.
- Endocarditis caused by E. faecium requires effective antibacterial strategies.
Observation:
- A patient with a history of endocarditis presented with persistent E. faecium bacteremia despite various antibiotic regimens.
- Initial treatment with daptomycin at escalating doses showed limited efficacy.
- Vancomycin minimum inhibitory concentration (MIC) was >256 µg/mL, and daptomycin MIC was 3-4 µg/mL.
Findings:
- The patient showed rapid clinical and microbiological improvement after the addition of tigecycline to daptomycin.
- Blood cultures remained negative for 9 weeks post-discharge.
- Daptomycin at 8 mg/kg daily did not cause creatine kinase elevation despite potential renal dysfunction.
Implications:
- Combination therapy with daptomycin and tigecycline may be a viable option for treating multidrug-resistant E. faecium endocarditis.
- Higher doses of daptomycin might enhance efficacy without compromising safety, even in patients with renal impairment.
- Further clinical data are needed to support these findings for E. faecium endocarditis treatment.
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