Ceftaroline-Resistant, Daptomycin-Tolerant, and Heterogeneous Vancomycin-Intermediate Methicillin-Resistant Staphylococcus aureus Causing Infective Endocarditis

Masayuki Nigo; Lorena Diaz; Lina P Carvajal; Truc T Tran; Rafael Rios; Diana Panesso; Juan D Garavito; William R Miller; Audrey Wanger; George Weinstock; Jose M Munita; Cesar A Arias; Henry F Chambers

doi:10.1128/AAC.01235-16

Ceftaroline-Resistant, Daptomycin-Tolerant, and Heterogeneous Vancomycin-Intermediate Methicillin-Resistant Staphylococcus aureus Causing Infective Endocarditis

Antimicrob Agents Chemother. 2017 Feb 23;61(3):e01235-16. doi: 10.1128/AAC.01235-16. Print 2017 Mar.

Authors

Masayuki Nigo¹, Lorena Diaz^{2

3}, Lina P Carvajal², Truc T Tran^{1

3}, Rafael Rios², Diana Panesso^{1

2

3}, Juan D Garavito², William R Miller^{1

3}, Audrey Wanger⁴, George Weinstock⁵, Jose M Munita^{1

2

3

6}, Cesar A Arias^{7

2

3}, Henry F Chambers⁸

Affiliations

¹ Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, Texas, USA.
² Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.
³ Center for Antimicrobial Resistance and Microbial Genomics, University of Texas McGovern Medical School, Houston, Texas, USA.
⁴ Department of Pathology and Laboratory Medicine, University of Texas Medical School at Houston, Houston, Texas, USA.
⁵ The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA.
⁶ Department of Medicine, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
⁷ 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.
⁸ 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.

Abstract

We report a case of infective endocarditis (IE) caused by ceftaroline-resistant, daptomycin-tolerant, and heterogeneous vancomycin-intermediate methicillin-resistant S. 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.

Keywords: Staphylococcus aureus; ceftaroline; endocarditis.

Publication types

Case Reports
Research Support, N.I.H., Extramural

MeSH terms

Adult
Amino Acid Substitution
Anti-Bacterial Agents / therapeutic use*
Bacterial Proteins / genetics*
Ceftaroline
Cephalosporins / therapeutic use
Cross Infection / drug therapy
Cross Infection / microbiology
Cross Infection / pathology
Daptomycin / therapeutic use*
Drug Resistance, Multiple, Bacterial / genetics*
Drug Therapy, Combination
Endocarditis, Bacterial / drug therapy*
Endocarditis, Bacterial / microbiology
Endocarditis, Bacterial / pathology
Gene Expression
Humans
Male
Methicillin / therapeutic use
Methicillin-Resistant Staphylococcus aureus / drug effects
Methicillin-Resistant Staphylococcus aureus / genetics
Methicillin-Resistant Staphylococcus aureus / growth & development
Microbial Sensitivity Tests
Penicillin-Binding Proteins / genetics*
Staphylococcal Infections / drug therapy*
Staphylococcal Infections / microbiology
Staphylococcal Infections / pathology
Vancomycin / therapeutic use*

Substances

Anti-Bacterial Agents
Bacterial Proteins
Cephalosporins
Penicillin-Binding Proteins
mecA protein, Staphylococcus aureus
Vancomycin
Daptomycin
Methicillin

Abstract

Publication types

MeSH terms

Substances

Grants and funding