Volume 18, Number 4—April 2012
Dispatch
De Novo Daptomycin-Nonsusceptible Enterococcal Infections
Table 1
Patient no., age, y/sex | Concurrent conditions† | Recent surgery | Site of isolation | Enterococcus species | Hospital day of DNSE isolation | Source of Enterococcus infection | Other pathogens isolated at DNSE site | Tx | Outcome of Enterococcus infection |
---|---|---|---|---|---|---|---|---|---|
1/69/M | RA on steroids, CHF, s/p AVR, s/p CABG | BKA, vascular surgery | Blood | E. faecium | 47 | CLABSI | None | DAP | Death |
2/70/M | Diabetes, bowel disease, ILD on steroids, lung transplant | Thoracic | Blood, pleural fluid empyema | E. faecium | 75 | CLABSI, empyema | None | LZD, Q-D, GEN | Death |
3/51/M | Colitis, TCC, severe hypocalcemia | No | Blood | E. faecium | 17 | CLABSI | None | VAN | Death |
4/53/F | CNS tumor | No | Urine | E. faecalis | 1 | Asymptomatic bacteriuria | None | None | Undetermined |
5/75/M | CVA | No | Urine | E. faecalis | 1 | UTI | None | LZD, VAN | Recovered |
6/62/M | AIDS | Soft tissue | Wound | E. faecium | 23 | Chronic decubitus ulcerations | E. coli, MRSA, Candida spp. | LZD | Undetermined |
7/64/F | Diabetes, bowel disease, splenectomy | GI tract | Abscess | E. gallinarum | 1 | Intra-abdominal abscess | Anaerobes, S. viridans | PIP/TAZ, ERT | Recovered |
8/26/F | Cirrhosis, ESRD, breast cancer | GI tract | Abscess | E. faecium | 65 | Liver abscess | E. coli, Klebsiella spp., Stenotro. | LZD | Death |
9/60/M | Diabetes, pancreatic cancer | No | Bile | E. faecium | 1 | Cholangitis | Fungi (C. glabrata, A. fumigatus, S. cerevisiae) | PIP/TAZ | Undetermined |
*DNSE, daptomycin-nonsusceptible enterococcus; Tx, treatment; RA, rheumatoid arthritis; CHF, congestive heart failure; AVR, aortic valve replacement; CABG, coronary artery bypass graft; BKA, below knee amputation; CLABSI, central line–associated bloodstream infection; DAP, daptomycin; ILD, interstitial lung disease; LZD, linezolid; Q-D, quinupristin/dalfopristin; GEN, gentamicin; TCC, transitional cell carcinoma; VAN, vancomycin; CNS, central nervous system; CVA, cerebrovascular accident; UTI, urinary tract infection; E. coli, Escherichia coli ; MRSA, methicillin-resistant Staphylococcus aureus; GI, gastrointestinal; S. viridans, Streptococcus viridans; PIP/TAZ, piperacillin/tazobactam;ESRD, end-stage renal disease; Stenotro., Stenotrophomonas; C. glabrata, Candida glabrata; A. fumigatus, Aspergillus fumigatus; S. cerevisiae, Saccharomyces cerevisiae
†Bowel disease was defined as presence of colitis, ischemic colitis, colonic ulcers, obstruction, or bowel surgery within 3 mo.