title: Characterization of daptomycin non-susceptible Enterococcus faecium producing urinary tract infection in a renal transplant recipient.
abstract: OBJECTIVE
  Characterization of a urine isolate of daptomycin non-susceptible Enterococcus faecium recovered from a patient with kidney transplantation and no history of daptomycin exposure.
  
  
  METHODS
  After isolation in a urine sample, identification of E. faecium was confirmed by amplification of the E. faecium-specific gene encoding D-alanyl-D-alanine ligase (ddl) and daptomycin susceptibility testing was performed by E-test on cation-adjusted Mueller-Hinton agar. In order to determine the genetic bases of daptomycin resistance, the open reading frames of five genes previously associated with daptomycin resistance in enterococci were sequenced.
  
  
  RESULTS
  Substitutions in the response regulator LiaR (S19F) and cardiolipin synthase (R218Q) were identified.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first characterization of emerging daptomycin resistance in E. faecium in a Spanish hospital in the absence of daptomycin exposure and in a renal transplant recipient.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sorlózano
authors.forename: Diana
authors.initials: D
authors.lastname: Panesso
authors.forename: José María
authors.initials: JM
authors.lastname: Navarro-Marí
authors.forename: Cesar A
authors.initials: CA
authors.lastname: Arias
authors.affiliation: José Gutiérrez-Fernández, Department of Microbiology, University of Granada Medical School, Av. de Madrid, 11 , 18012 Granada, Spain. josegf@ugr.es.
authors.forename: José
authors.initials: J
authors.lastname: Gutiérrez-Fernández
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics; D003428:Cross Infection / Q000382:microbiology*; D017576:Daptomycin / Q000494:pharmacology*; D004352:Drug Resistance, Microbial / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial; D016984:Enterococcus faecium / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D005921:Glomerulonephritis / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology*; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D010453:Peptide Synthases / Q000235:genetics; D011183:Postoperative Complications / Q000382:microbiology*; D014552:Urinary Tract Infections / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D010453:Peptide Synthases; C019638:D-alanylalanine synthetase; D017576:Daptomycin