title: Successful treatment of a left ventricular assist device infection with daptomycin non-susceptible methicillin-resistant Staphylococcus aureus: case report and review of the literature.
abstract: Recipients of left ventricular assist devices (LVADs) are highly susceptible to the development of infections with multidrug-resistant (MDR) organisms. We describe the case of a patient with an LVAD who developed a device-related, daptomycin non-susceptible, methicillin-resistant Staphylococcus aureus infection, highlighting this patient population as highly vulnerable to the development of such antimicrobial resistance. This report includes a thorough review of the literature on the mechanisms of development of daptomycin non-susceptibility and suggests ways to prevent its emergence. We also provide and underscore the appropriate guidelines to abide by when attempting to control infections with such resistant isolates. This case also demonstrates the importance of definitive treatment with LVAD removal and transplantation as a component of appropriate management of invasive LVAD infections. In addition, we suggest that even infections with MDR organisms may not adversely affect post-transplant outcomes.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467-2490, USA. danlevy@montefiore.org
authors.forename: D T
authors.initials: DT
authors.lastname: Levy
authors.forename: M E
authors.initials: ME
authors.lastname: Steed
authors.forename: M J
authors.initials: MJ
authors.lastname: Rybak
authors.forename: Y
authors.initials: Y
authors.lastname: Guo
authors.forename: P
authors.initials: P
authors.lastname: Gialanella
authors.forename: L
authors.initials: L
authors.lastname: Hanau
authors.forename: V
authors.initials: V
authors.lastname: Muggia
authors.forename: B
authors.initials: B
authors.lastname: Ostrowsky
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017576:Daptomycin / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D006353:Heart-Assist Devices / Q000382:microbiology*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin