title: Daptomycin resistance in prosthetic joint infections.
abstract: Antimicrobial resistance has been problematic since the advent of antibiotics. Patients with prosthetic joint infections often require prolonged courses of antibiotic therapy, with resistance commonly being the consequence. The rapid evolution of resistance poses a serious challenge in the treatment of infections and creates a need for new agents with novel mechanisms of bactericidal activity. Daptomycin, a cyclic lipopeptide naturally produced by Streptomyces roseosporus, is a newer agent approved for use in complicated skin, soft tissue, and prosthetic joint infections. To our knowledge, this article describes the first case of daptomycin-resistant heterogenous vancomycin intermediate-resistant Staphylococcus aureus (hVISA) in an 82-year-old man undergoing elective total knee arthroplasty in Queensland, Australia, with a subsequent deep prosthetic joint infection.A literature review is presented, and the increasing number of multi-resistant organisms and their implications for orthopedics are discussed. Worldwide reports of hVISA are reviewed. To our knowledge, this is the first article to describe daptomycin resistance in prosthetic joint infections. The role of newer antimicrobial agents, such as daptomycin, and strategies to minimize antibiotic resistance are examined.
authors.affiliation: Department of Orthopedic Surgery, The Prince Charles Hospital, Chermside, Australia.
authors.forename: Brahman
authors.initials: B
authors.lastname: Sivakumar
authors.forename: Praveen
authors.initials: P
authors.lastname: Vijaysegaran
authors.forename: Alex
authors.initials: A
authors.lastname: Chaudhuri
authors.forename: Scott
authors.initials: S
authors.lastname: Crawford
authors.forename: Michael
authors.initials: M
authors.lastname: Ottley
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017576:Daptomycin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D016908:Gram-Positive Bacterial Infections / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D016459:Prosthesis-Related Infections / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin