Treatment of High-Level Gentamicin-Resistant Enterococcus faecalis

A recurrent case of left-sided endocarditis caused by high-level aminoglycoside-resistant Enterococcus faecalis was successfully treated with ceftaroline and daptomycin. This combination demonstrated excellent synergy in vitro. Mechanistically, ceftaroline enhanced binding of daptomycin to the cell membrane and sensitized E. faecalis to killing by human cathelicidin LL-37, a cat-ionic innate host defense peptide. Daptomycin plus ceftaroline may be considered in salvage therapy in E. faecalis endovascular infections and requires further study. A63-year-old man with a past medical history significant forhypertension presented with fevers for 1 month. The patient received levofloxacin and doxycycline for presumed prostatitis. Physical examination revealed a grade 2 systolic murmur and grade 1 diastolicmurmur. Blood cultures were positive for Entero-coccus faecalis. The patient was admitted to the hospital and started on ampicillin-sulbactam and gentamicin. The white blood cell count (WBC) was 10,100 cells/mm3, hemoglobin was 14 g/dl, and the chest X-ray was normal. Repeat blood cultures showed ampicillin-susceptible E. faecaliswith high-level gentamicin resis-tance (HLGR). A transesophageal echocardiogram revealed