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Two Cases of Vancomycin Resistant Enterococcus faecium Bacteremia with Development of Daptomycin Resistant Phenotype and its Detection Using Oxford Nanopore Sequencing

Zulema Udaondo, Piroon Jenjaroenpun, Thidathip Wongsurawat, Erik Meyers, Courtney Anderson, James Lopez, Meera Mohan, Ruslana Tytarenko, Brian Walker, Sciprofile linkDavid Ussery, Sciprofile linkAtul Kothari, Sciprofile linkSe-Ran Jun
Open Forum Infectious Diseases ; doi:10.1093/ofid/ofaa180

Abstract: In this work, we report two cases of vancomycin resistant Enterococcus faecium bacteremia with development of daptomycin resistance from two patients with acute myeloid leukemia (AML), and myelodysplastic syndrome. Mutations related to daptomycin non-susceptible phenotype in liaSR genes were found in all strains of the study, including those with MIC < 1 µg/ml collected before daptomycin therapy. Epidemiological investigation using cgSNP and cgMLST revealed clonality of all the isolates. In this study, we conclude that real-time genome sequencing of clinical isolates can provide rapid access to timely information of daptomycin resistant genotypes that would help clinicians speed up and optimize the selection of the antibiotic for treatment.
Keywords: Treatment / Vancomycin / Bacteremia / optimize / Enterococcus Faecium / Daptomycin Resistant

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