Your browser doesn't support javascript.
loading
In vivo development of daptomycin resistance in vancomycin-susceptible methicillin-resistant Staphylococcus aureus severe infections previously treated with glycopeptides.
Capone, A; Cafiso, V; Campanile, F; Parisi, G; Mariani, B; Petrosillo, N; Stefani, S.
Afiliación
  • Capone A; National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
  • Cafiso V; Department of Biomedical and Biotechnological Sciences, MMAR Laboratory, University of Catania, Catania, Italy. v.cafiso@unict.it.
  • Campanile F; Department of Biomedical and Biotechnological Sciences, MMAR Laboratory, University of Catania, Catania, Italy.
  • Parisi G; Department of Microbiology, San Camillo-Forlanini Hospital, Rome, Italy.
  • Mariani B; Department of Microbiology, San Camillo-Forlanini Hospital, Rome, Italy.
  • Petrosillo N; National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
  • Stefani S; Department of Biomedical and Biotechnological Sciences, MMAR Laboratory, University of Catania, Catania, Italy.
Eur J Clin Microbiol Infect Dis ; 35(4): 625-31, 2016 Apr.
Article en En | MEDLINE | ID: mdl-26815434
Our aim was to describe the clinical and microbiological features of four cases of severe vancomycin-susceptible methicillin-resistant Staphylococcus aureus (MRSA) infections in which the vancomycin non-susceptibility development and daptomycin resistance occurred under therapy with teicoplanin (three cases) and daptomycin switched to vancomycin (one case). Clinical data were retrospectively reviewed. On nine clinical epidemiologically unrelated daptomycin-susceptible (DAP-S) and daptomycin-resistant (DAP-R) MRSA, we performed: (i) DAP-VAN-TEC-CFX-RIF minimum inhibitory concentrations (MICs); (ii) glycopeptide resistance detection (GRD) by δ-hemolysis; (iii) glycopeptide population analysis; (iv) molecular characterization by PFGE-MLST-SCCmec-agr-typing; (v) rpoB and mprF single nucleotide polymorphisms (SNPs); (vi) dltA-mprF-atl-sceD expression by real-time quantitative polymerase chain reaction (qPCR). Three out of the four patients did not survive despite salvage treatment; two died with active MRSA infection and one died because of Stenotrophomonas maltophilia sepsis. The fourth patient, in which a reversion to a DAP-S phenotype occurred, survived with daptomycin plus trimethoprim/sulfamethoxazole and oxacillin treatment, and endovascular device removal. Daptomycin resistance development was preceded by a stable heterogeneous vancomycin-intermediate S. aureus (hVISA) or VISA phenotype acquisition, while in one case, daptomycin resistance was preceded by an unstable daptomycin heteroresistance (hDAP) behavior reverting to DAP-S during vancomycin plus rifampin therapy followed by high doses of daptomycin. All DAP-R strains showed hVISA or DAP-R traits, including mutations and/or up-regulation of genes involved in cell wall turnover and cell membrane perturbation. In our study, daptomycin resistance arose during glycopeptide therapy. The emergence of DAP-R isolates was preceded by a stable VISA or hVISA phenotype or by instability reverting to a DAP-S heteroresistant phenotype. Daptomycin, as first-line therapy for the treatment of severe MRSA infections, should be used at optimal dosage combined with other agents such as beta-lactams, to prevent daptomycin resistance occurrence.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones Estafilocócicas / Vancomicina / Daptomicina / Farmacorresistencia Bacteriana / Staphylococcus aureus Resistente a Meticilina / Antibacterianos Tipo de estudio: Observational_studies Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: Eur J Clin Microbiol Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS / MICROBIOLOGIA Año: 2016 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Alemania

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones Estafilocócicas / Vancomicina / Daptomicina / Farmacorresistencia Bacteriana / Staphylococcus aureus Resistente a Meticilina / Antibacterianos Tipo de estudio: Observational_studies Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: Eur J Clin Microbiol Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS / MICROBIOLOGIA Año: 2016 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Alemania