title: In vivo development of heterogeneous glycopeptide-intermediate Staphylococcus aureus (hGISA), GISA and daptomycin resistance in a patient with meticillin-resistant S. aureus endocarditis.
abstract: We report a patient who developed a meticillin-resistant Staphylococcus aureus (MRSA) central venous catheter infection complicated by infective endocarditis. The patient was initially treated with glycopeptides, which led to the development of heterogeneous glycopeptide resistance, the detection of which required the use of a macro Etest screening test. Subsequently, the causative strain, confirmed by PFGE as a UK epidemic MRSA-15, was treated with daptomycin, and again resistance developed in vivo. The development in vivo of resistance to both these agents suggests that the resistance mechanisms may be associated. We suggest that the clinician managing MRSA infection should anticipate daptomycin resistance when reduced glycopeptide susceptibility is detected.
authors.affiliation: Department of Infection & Host Defence, Liverpool University, 8th Floor Duncan Building, Daulby Street, Liverpool L69 3GA, UK.|Department of Medical Microbiology, Royal Liverpool & Broadgreen University Hospital Trust, Prescot Street, Liverpool, Merseyside L7 8XP, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirby
authors.affiliation: Department of Medical Microbiology, Royal Liverpool & Broadgreen University Hospital Trust, Prescot Street, Liverpool, Merseyside L7 8XP, UK.
authors.forename: Kavya
authors.initials: K
authors.lastname: Mohandas
authors.affiliation: Department of Infection & Host Defence, Liverpool University, 8th Floor Duncan Building, Daulby Street, Liverpool L69 3GA, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Broughton
authors.affiliation: Department of Medical Microbiology, Royal Liverpool & Broadgreen University Hospital Trust, Prescot Street, Liverpool, Merseyside L7 8XP, UK.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Neal
authors.affiliation: Department of Medical Microbiology, Royal Liverpool & Broadgreen University Hospital Trust, Prescot Street, Liverpool, Merseyside L7 8XP, UK.
authors.forename: Godfrey W
authors.initials: GW
authors.lastname: Smith
authors.affiliation: Department of Nephrology, Royal Liverpool & Broadgreen University Hospital Trust, Prescot Street, Liverpool, Merseyside L7 8XP, UK.
authors.forename: Pearl
authors.initials: P
authors.lastname: Pai
authors.affiliation: Department of Medical Microbiology, Royal Liverpool & Broadgreen University Hospital Trust, Prescot Street, Liverpool, Merseyside L7 8XP, UK.
authors.forename: Carlos
authors.initials: C
authors.lastname: Nistal de Paz
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000382:microbiology; D017576:Daptomycin / Q000494:pharmacology* / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D006020:Glycopeptides / Q000494:pharmacology* / Q000627:therapeutic use; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D008943:Mitral Valve / Q000601:surgery; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D017576:Daptomycin