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Emerging issues on Staphylococcus aureus endocarditis and the role in therapy of daptomycin plus fosfomycin

Cristina García de la Mària1, Maria-Alexandra Cañas1, Mariana Fernández-Pittol2

  • 1Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain.

Expert Review of Anti-Infective Therapy
|February 6, 2023
PubMed
Abstract

Insights

Fosfomycin combined with daptomycin shows promise for treating Staphylococcus aureus infections, including MRSA. This combination may improve outcomes for difficult-to-treat conditions like infective endocarditis.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Microbiology

Background:

  • Staphylococcus aureus (S. aureus) infections, including methicillin-resistant S. aureus (MRSA), pose significant global health challenges.
  • S. aureus bacteremia leads to high morbidity and mortality, often causing severe complications like infective endocarditis (IE).
  • The increasing antibiotic resistance of S. aureus necessitates the development of novel therapeutic strategies.

Purpose of the Study:

  • To evaluate the potential of combining daptomycin with fosfomycin for treating S. aureus infections.
  • To assess the efficacy and synergistic effects of the daptomycin-fosfomycin combination, particularly in cases of MRSA infective endocarditis.

Main Methods:

  • Literature review of current therapeutic options for S. aureus infections.
  • Exploration of antibiotic combination therapies, focusing on daptomycin and fosfomycin.
  • Analysis of fosfomycin's mechanism of action and its impact on daptomycin efficacy and resistance.

Main Results:

  • Daptomycin demonstrates rapid bactericidal activity against MRSA and is comparable to vancomycin for MRSA bacteremia.
  • Therapy failures with daptomycin monotherapy are associated with deep-seated infections and high bacterial loads.
  • Fosfomycin exhibits a unique mechanism of action and is effective in preventing daptomycin resistance and optimizing its efficacy.

Conclusions:

  • The combination of fosfomycin with daptomycin presents a synergistic effect.
  • This combination is a promising alternative treatment for both methicillin-susceptible S. aureus (MSSA) and MRSA infective endocarditis.
  • Optimizing daptomycin efficacy and preventing resistance are key benefits of this therapeutic approach.
Keywords:
Methicillin-sensitive Staphylococcus aureusbactericidal activitycombined therapydaptomycinfosfomycininfective endocarditismethicillin-resistant Staphylococcus aureussynergy

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