Emergence of dalbavancin non-susceptible methicillin-resistant Staphylococcus epidermidis (MRSE) in a patient treated with dalbavancin prolonged therapy: Case report, therapeutic drug monitoring and genomic characterization.
Simone Giuliano, PierGiorgio Cojutti, Michela Bulfoni et al.
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Case in brief
A patient with recurrent bloodstream infections caused by methicillin-resistant Staphylococcus epidermidis (MRSE) was treated with dalbavancin over three years. During this period, four related MRSE isolates were identified, showing progressive increases in dalbavancin minimum inhibitory concentration (MIC). Genetic analysis revealed specific mutations associated with reduced susceptibility. Despite optimal drug exposure, resistance emerged, necessitating consideration of combination therapies.
What made this case unusual
The case highlights the stepwise evolution of dalbavancin non-susceptibility in MRSE during prolonged therapy, revealing multiple genetic mutations contributing to resistance.
Diagnostic / clinical pearl
Clinicians should be aware that prolonged dalbavancin therapy can lead to the emergence of resistant MRSE strains, even with adequate drug exposure.
Why it matters
This case emphasizes the importance of monitoring for resistance development and considering combination therapies to mitigate the risk of treatment failure in MRSE infections.