Abstract
Rationale: Daptomycin (DAP) is a key drug for treating severe Staphylococcus infections. The emergence of DAP non-susceptible Staphylococcus aureus has been widely recognized in clinical situations, although the clinical status of DAP non-susceptible coagulase-negative Staphylococcus (CoNS) infections is unclear. We encountered 2 cases of cardiovascular device infections that were associated with DAP non-susceptible CoNS. Patient concerns: The first case involved a 60-year-old woman with a pump pocket infection in a left ventricular assist device. DAP non-susceptible Staphylococcus capitis subsp. ureolyticus was isolated from a blood culture after treatment using vancomycin (10 days) and DAP (6 days). The second case involved a 71-year-old man with an aortic graft infection. DAP non-susceptible S capitis subsp. ureolyticus was detected in pus after treatment using vancomycin (2 weeks) and DAP (1 week) without complete removal and debridement. Diagnosis: Cardiovascular device infections caused by DAP non-susceptible CoNS. Interventions and outcomes: Whole genome sequencing of these strains revealed multiple mutations in genes that are related to DAP-non-susceptibility in S aureus, which created amino acid substitutions in mprF, dltAB, dltD, rpoC, yycG, cls2, pgsA, and vraSR. To the very best of our knowledge, the substitution patterns were not identical to those previously reported in DAP non-susceptibile S aureus. Lessons: Clinicians should be cautious regarding the emergence of DAP non-susceptible CoNS, especially in cases with implanted prosthetic devices, inadequate debridement, and prior usage of vancomycin and DAP. Further studies are needed to understand the relevance of these genetic changes and DAP-non-susceptibility in CoNS strains.
| Original language | English |
|---|---|
| Article number | e13487 |
| Journal | Medicine (United States) |
| Volume | 97 |
| Issue number | 49 |
| DOIs | |
| Publication status | Published - Dec 1 2018 |
| Externally published | Yes |
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Keywords
- Amino acid substitution
- Antimicrobial resistance
- Daptomycin
- Prosthetic device
- Staphylococcus capitis subsp
- Ureolyticus
- Whole genome analysis
ASJC Scopus subject areas
- Medicine(all)
Cite this
Emergence of daptomycin non-susceptible coagulase-negative staphylococci in patients with cardiovascular device infections Two cases report investigated by whole genome analysis. / Hagiya, Hideharu; Sugawara, Yo; Kimura, Keigo; Hamaguchi, Shigeto; Nishi, Isao; Hayashi, Masahiro; Akeda, Yukihiro; Tomono, Kazunori.
In: Medicine (United States), Vol. 97, No. 49, e13487, 01.12.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Emergence of daptomycin non-susceptible coagulase-negative staphylococci in patients with cardiovascular device infections Two cases report investigated by whole genome analysis
AU - Hagiya, Hideharu
AU - Sugawara, Yo
AU - Kimura, Keigo
AU - Hamaguchi, Shigeto
AU - Nishi, Isao
AU - Hayashi, Masahiro
AU - Akeda, Yukihiro
AU - Tomono, Kazunori
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Rationale: Daptomycin (DAP) is a key drug for treating severe Staphylococcus infections. The emergence of DAP non-susceptible Staphylococcus aureus has been widely recognized in clinical situations, although the clinical status of DAP non-susceptible coagulase-negative Staphylococcus (CoNS) infections is unclear. We encountered 2 cases of cardiovascular device infections that were associated with DAP non-susceptible CoNS. Patient concerns: The first case involved a 60-year-old woman with a pump pocket infection in a left ventricular assist device. DAP non-susceptible Staphylococcus capitis subsp. ureolyticus was isolated from a blood culture after treatment using vancomycin (10 days) and DAP (6 days). The second case involved a 71-year-old man with an aortic graft infection. DAP non-susceptible S capitis subsp. ureolyticus was detected in pus after treatment using vancomycin (2 weeks) and DAP (1 week) without complete removal and debridement. Diagnosis: Cardiovascular device infections caused by DAP non-susceptible CoNS. Interventions and outcomes: Whole genome sequencing of these strains revealed multiple mutations in genes that are related to DAP-non-susceptibility in S aureus, which created amino acid substitutions in mprF, dltAB, dltD, rpoC, yycG, cls2, pgsA, and vraSR. To the very best of our knowledge, the substitution patterns were not identical to those previously reported in DAP non-susceptibile S aureus. Lessons: Clinicians should be cautious regarding the emergence of DAP non-susceptible CoNS, especially in cases with implanted prosthetic devices, inadequate debridement, and prior usage of vancomycin and DAP. Further studies are needed to understand the relevance of these genetic changes and DAP-non-susceptibility in CoNS strains.
AB - Rationale: Daptomycin (DAP) is a key drug for treating severe Staphylococcus infections. The emergence of DAP non-susceptible Staphylococcus aureus has been widely recognized in clinical situations, although the clinical status of DAP non-susceptible coagulase-negative Staphylococcus (CoNS) infections is unclear. We encountered 2 cases of cardiovascular device infections that were associated with DAP non-susceptible CoNS. Patient concerns: The first case involved a 60-year-old woman with a pump pocket infection in a left ventricular assist device. DAP non-susceptible Staphylococcus capitis subsp. ureolyticus was isolated from a blood culture after treatment using vancomycin (10 days) and DAP (6 days). The second case involved a 71-year-old man with an aortic graft infection. DAP non-susceptible S capitis subsp. ureolyticus was detected in pus after treatment using vancomycin (2 weeks) and DAP (1 week) without complete removal and debridement. Diagnosis: Cardiovascular device infections caused by DAP non-susceptible CoNS. Interventions and outcomes: Whole genome sequencing of these strains revealed multiple mutations in genes that are related to DAP-non-susceptibility in S aureus, which created amino acid substitutions in mprF, dltAB, dltD, rpoC, yycG, cls2, pgsA, and vraSR. To the very best of our knowledge, the substitution patterns were not identical to those previously reported in DAP non-susceptibile S aureus. Lessons: Clinicians should be cautious regarding the emergence of DAP non-susceptible CoNS, especially in cases with implanted prosthetic devices, inadequate debridement, and prior usage of vancomycin and DAP. Further studies are needed to understand the relevance of these genetic changes and DAP-non-susceptibility in CoNS strains.
KW - Amino acid substitution
KW - Antimicrobial resistance
KW - Daptomycin
KW - Prosthetic device
KW - Staphylococcus capitis subsp
KW - Ureolyticus
KW - Whole genome analysis
UR - http://www.scopus.com/inward/record.url?scp=85058774218&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85058774218&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000013487
DO - 10.1097/MD.0000000000013487
M3 - Article
C2 - 30544442
AN - SCOPUS:85058774218
VL - 97
JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries
JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries
SN - 0025-7974
IS - 49
M1 - e13487
ER -