title: Ceftaroline-Resistant, Daptomycin-Tolerant, and Heterogeneous Vancomycin-Intermediate Methicillin-Resistant Staphylococcus aureus Causing Infective Endocarditis.
abstract: We report a case of infective endocarditis (IE) caused by ceftaroline-resistant, daptomycin-tolerant, and heterogeneous vancomycin-intermediate methicillin-resistantS. aureus(MRSA). Resistance to ceftaroline emerged in the absence of drug exposure, and the E447K substitution in the active site of PBP2a previously associated with ceftaroline resistance was identified. Additionally, we present evidence of patient-to-patient transmission of the strain within the same unit. This case illustrates the difficulties in treating MRSA IE in the setting of a multidrug-resistant phenotype.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nigo
authors.affiliation: Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.|Center for Antimicrobial Resistance and Microbial Genomics, University of Texas McGovern Medical School, Houston, Texas, USA.
authors.forename: Lorena
authors.initials: L
authors.lastname: Diaz
authors.affiliation: Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.
authors.forename: Lina P
authors.initials: LP
authors.lastname: Carvajal
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, Texas, USA.|Center for Antimicrobial Resistance and Microbial Genomics, University of Texas McGovern Medical School, Houston, Texas, USA.
authors.forename: Truc T
authors.initials: TT
authors.lastname: Tran
authors.affiliation: Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.
authors.forename: Rafael
authors.initials: R
authors.lastname: Rios
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, Texas, USA.|Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.|Center for Antimicrobial Resistance and Microbial Genomics, University of Texas McGovern Medical School, Houston, Texas, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Panesso
authors.affiliation: Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Garavito
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, Texas, USA.|Center for Antimicrobial Resistance and Microbial Genomics, University of Texas McGovern Medical School, Houston, Texas, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Miller
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Audrey
authors.initials: A
authors.lastname: Wanger
authors.affiliation: The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA.
authors.forename: George
authors.initials: G
authors.lastname: Weinstock
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, Texas, USA.|Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.|Center for Antimicrobial Resistance and Microbial Genomics, University of Texas McGovern Medical School, Houston, Texas, USA.|Department of Medicine, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Munita
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, Texas, USA cesar.arias@uth.tmc.edu henry.chambers@ucsf.edu.|Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.|Center for Antimicrobial Resistance and Microbial Genomics, University of Texas McGovern Medical School, Houston, Texas, USA.
authors.forename: Cesar A
authors.initials: CA
authors.lastname: Arias
authors.affiliation: Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA cesar.arias@uth.tmc.edu henry.chambers@ucsf.edu.
authors.forename: Henry F
authors.initials: HF
authors.lastname: Chambers
mesh_terms: D000328:Adult; D019943:Amino Acid Substitution; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000235:genetics*; D002511:Cephalosporins / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D017576:Daptomycin / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D015870:Gene Expression; D006801:Humans; D008297:Male; D008712:Methicillin / Q000627:therapeutic use; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000235:genetics / Q000254:growth & development; D008826:Microbial Sensitivity Tests; D046915:Penicillin-Binding Proteins / Q000235:genetics*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D014640:Vancomycin / Q000627:therapeutic use*; D000097583:Ceftaroline
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D002511:Cephalosporins; D017576:Daptomycin; D008712:Methicillin; D046915:Penicillin-Binding Proteins; D014640:Vancomycin; D000097583:Ceftaroline; C487789:mecA protein, Staphylococcus aureus
keywords: Staphylococcus aureus; ceftaroline; endocarditis