耐头孢洛林、耐达托霉素及异质性万古霉素中介的耐甲氧西林金黄色葡萄球菌致感染性心内膜炎
Ceftaroline-Resistant, Daptomycin-Tolerant, and Heterogeneous Vancomycin-Intermediate Methicillin-Resistant Staphylococcus aureus Causing Infective Endocarditis.
作者信息
Nigo Masayuki, Diaz Lorena, Carvajal Lina P, Tran Truc T, Rios Rafael, Panesso Diana, Garavito Juan D, Miller William R, Wanger Audrey, Weinstock George, Munita Jose M, Arias Cesar A, Chambers Henry F
机构信息
Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, Texas, USA.
Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.
出版信息
Antimicrob Agents Chemother. 2017 Feb 23;61(3). doi: 10.1128/AAC.01235-16. Print 2017 Mar.
Abstract
We report a case of infective endocarditis (IE) caused by ceftaroline-resistant, daptomycin-tolerant, and heterogeneous vancomycin-intermediate methicillin-resistant (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.
摘要
我们报告了一例由耐头孢托罗、耐达托霉素且对万古霉素呈异质性中介耐药的耐甲氧西林金黄色葡萄球菌（MRSA）引起的感染性心内膜炎（IE）病例。在未接触药物的情况下出现了对头孢托罗的耐药性，并且在先前与头孢托罗耐药性相关的PBP2a活性位点中鉴定出E447K替代。此外，我们提供了该菌株在同一病房内患者之间传播的证据。该病例说明了在多重耐药表型情况下治疗MRSA IE的困难。
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