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Treatment of high-level gentamicin-resistant Enterococcus faecalis endocarditis with daptomycin plus ceftaroline
George Sakoulas1, Poochit Nonejuie, Victor Nizet
1Department of Pediatric Pharmacology and Drug Discovery, University of California San Diego School of Medicine, La Jolla, California, USA. gsakoulas@ucsd.edu
Antimicrobial Agents and Chemotherapy
|May 22, 2013
Summary
A recurrent Enterococcus faecalis endocarditis case was treated with ceftaroline and daptomycin. This antibiotic combination showed synergy, offering a potential salvage therapy for resistant bacterial infections.
Area of Science:
- Infectious Diseases
- Pharmacology
- Microbiology
Background:
- Endocarditis is a serious infection of the heart lining.
- High-level aminoglycoside resistance in Enterococcus faecalis complicates treatment.
- Recurrent infections pose significant therapeutic challenges.
Observation:
- A patient with recurrent left-sided endocarditis due to resistant Enterococcus faecalis was treated.
- The treatment regimen involved a combination of ceftaroline and daptomycin.
- In vitro studies were conducted to assess the antibiotic combination's efficacy and mechanism.
Findings:
- The combination of ceftaroline and daptomycin demonstrated excellent in vitro synergy against resistant Enterococcus faecalis.
- Ceftaroline was observed to enhance daptomycin's binding to the bacterial cell membrane.
- The combination sensitized Enterococcus faecalis to killing by the host defense peptide LL-37.
Implications:
- Ceftaroline plus daptomycin may represent a viable salvage therapy option for challenging Enterococcus faecalis endovascular infections.
- Further clinical studies are warranted to confirm the efficacy and safety of this combination.
- Understanding the synergistic mechanisms can inform future antibiotic development for resistant pathogens.
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