Successful Treatment of Vancomycin-Resistant Enterococcus species Bone and Joint Infection with Daptomycin Plus Beta Lactam Agents

Abstract

Bone and joint infections (BJI) caused by vancomycin-resistant Enterococcus spp. (VRE) are difficult to treat due to limited antibiotic options. Although linezolid can be used for VRE treatment, it is often discontinued due to time-dependent bone marrow suppression. Daptomycin, a lipopeptide antibiotic agent with rapid bactericidal activity, is another available therapeutic option for VRE infections. We report a case of VRE BJI successfully treated with a high dose of daptomycin plus β-lactam agents. An 84-year-old man received linezolid for the treatment of VRE BJI. After 2 weeks of therapy, the patient experienced bleeding events associated with linezolid-induced bone marrow toxicity and linezolid was discontinued. Next, high-dose daptomycin therapy combined with a β-lactam agent was selected to treat the remaining VRE BJI. During daptomycin treatment, microbiological eradication was achieved, and the patient clinically improved without evidence of adverse events. We highlight the need for daptomycin use for the treatment of VRE infections, especially in cases where linezolid is ineffective.

Keywords: Bone and joint infection; Daptomycin; Enterococcus spp.

Figure 1. Computer tomography scan of abscess formation around the right hip joint indicating deep seated surgical site infection (blue arrows) with foreign body (red arrow) on hospital day 28.

Figure 2. Computer tomography scan of the hip joint showing reduced abscess and soft tissue swelling (blue arrows) in the right hip joint on hospital day 76.

Figure 3. Clinical course of bone and joint infection caused by vancomycin-resistant Enterococcus faecium according to antibiotic use and intervention.

^aCarbapenem was used for the treatment of central line-associated bloodstream infection caused by extended spectrum β-lactamase-producing Klebsiella pneumoniae.