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Direct Microbial Identification using An Automated Microbial Identification System to Facilitate the EUCAST RAST Method Without Mass Spectrometry
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A current perspective on daptomycin for the clinical microbiologist.

Romney M Humphries1, Simon Pollett, George Sakoulas

  • 1Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, USA.

Clinical Microbiology Reviews
|October 5, 2013
PubMed
Summary
This summary is machine-generated.

Daptomycin is an effective antibiotic against Gram-positive bacteria, but resistance is increasing. Understanding daptomycin nonsusceptibility mechanisms is crucial for treating serious infections caused by Staphylococcus aureus and Enterococcus species.

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Area of Science:

  • * Antimicrobial resistance
  • * Infectious diseases
  • * Clinical microbiology

Background:

  • * Daptomycin, a lipopeptide antibiotic, has been clinically used since 2004 for Gram-positive bacterial infections.
  • * Significant data support its efficacy in treating severe infections like bacteremia and endocarditis.
  • * Emerging daptomycin nonsusceptibility in key pathogens, including Staphylococcus aureus and Enterococcus species, poses a clinical challenge.

Purpose of the Study:

  • * To review the current data on daptomycin's efficacy and usage.
  • * To explore the mechanisms underlying daptomycin nonsusceptibility in major Gram-positive pathogens.
  • * To discuss the challenges in clinical laboratory susceptibility testing for daptomycin.

Main Methods:

  • * Comprehensive literature review of daptomycin's clinical use, activity, and resistance.
  • * Analysis of reported mechanisms of daptomycin nonsusceptibility.
  • * Examination of clinical laboratory practices and challenges in susceptibility testing.

Main Results:

  • * Daptomycin exhibits potent bactericidal activity against Gram-positive bacteria.
  • * Nonsusceptibility is increasingly reported, particularly in Staphylococcus aureus, Enterococcus faecium, and Enterococcus faecalis.
  • * Mechanisms of nonsusceptibility involve adaptations in cell wall homeostasis and membrane phospholipid metabolism.
  • * Challenges exist in accurate daptomycin susceptibility testing and reporting of minimum inhibitory concentrations (MICs).

Conclusions:

  • * Daptomycin remains a vital therapeutic option for serious Gram-positive infections.
  • * Understanding and monitoring daptomycin nonsusceptibility are critical for effective treatment strategies.
  • * Standardization of laboratory testing is needed to ensure accurate susceptibility reporting.