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High-dose daptomycin and fosfomycin treatment of a patient with endocarditis caused by daptomycin-nonsusceptible Staphylococcus aureus: Case report

Liang-Yu Chen13, Cheng-Hsiung Huang23, Shu-Chen Kuo13, Chen-Yuan Hsiao2, Mei-Lin Lin1, Fu-Der Wang13* and Chang-Phone Fung13

Author Affiliations

1 Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

2 Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

3 School of Medicine, National Yang-Ming University, Taipei, Taiwan

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BMC Infectious Diseases 2011, 11:152  doi:10.1186/1471-2334-11-152

Published: 26 May 2011



Emergence of daptomycin-nonsusceptible (DNS) Staphylococcus aureus is a dreadful problem in the treatment of endocarditis. Few current therapeutic agents are effective for treating infections caused by DNS S. aureus.

Case presentation

We describe the emergence of DNS S. aureus. in a patient with implantable cardioverter-defibrillator (ICD) device -related endocarditis who was priorily treated with daptomycin. Metastatic dissemination as osteomyelitis further complicated the management of endocarditis. The dilemma was successfully managed by surgical removal of the ICD device and combination antimicrobial therapy with high-dose daptomycin and fosfomycin.


Surgical removal of intracardiac devices remains an important adjunctive measure in the treatment of endocarditis. Our case suggests that combination therapy is more favorable than single-agent therapy for infections caused by DNS S. aureus.

Daptomycin-nonsusceptible; fosfomycin; ICD device-related endocarditis