title: A febrile neutropenic patient with Enterococcus gallinarum sepsis treated with daptomycin and gentamicin.
abstract: Gram-positive pathogens are increasingly implicated in today's changing epidemiology of hospital-acquired infections. Staphylococci, streptococci, and enterococci are among the most frequently identified causes of surgical site, complicated skin-structure, and bloodstream infections. In accordance, the use of antimicrobial agents with gram-positive activity, especially those with activity against resistant organisms, has also increased. We describe a septic, neutropenic patient with bacteremia due to Enterococcus gallinarum. Therapeutic options were restricted due to resistance factors of the organism, limited guidance in the medical literature, and the patient's history and underlying condition. Despite these challenges, the patient was successfully treated with a combination of daptomycin and gentamicin and replacement of her indwelling central line. As antimicrobial stewards and diagnosticians, we must bear in mind that selective pressures exerted by the increasing use of agents with gram-positive activity may result in an increased prevalence of organisms such as E. gallinarum.
authors.affiliation: Department of Pharmacy Services, University of Colorado Hospital, Denver, Colorado 80262, USA.
authors.forename: Gerard R
authors.initials: GR
authors.lastname: Barber
authors.forename: Joseph
authors.initials: J
authors.lastname: Lauretta
authors.forename: Ruben
authors.initials: R
authors.lastname: Saez
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D002408:Catheters, Indwelling; D003428:Cross Infection / Q000188:drug therapy; D017576:Daptomycin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D016983:Enterococcus / Q000187:drug effects; D005260:Female; D005334:Fever; D005839:Gentamicins / Q000627:therapeutic use*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D017576:Daptomycin