%0 Journal Article %A O'Connor, Ciara %A Casserly, Liam F. %A Qazi, Junaid %A Power, Lorraine %A Finnegan, Cathriona %A O'Connell, Nuala H. %A Dunne, Colum P. %T A case of fatal daptomycin-resistant, vancomycin-resistant enterococcal infective endocarditis in end-stage kidney disease %D 2015 %J JMM Case Reports, %V 2 %N 5 %@ 2053-3721 %C e000089 %R https://doi.org/10.1099/jmmcr.0.000089 %K resistance %K Daptomycin %K end-stage kidney disease (ESKD) %K vancomycin-resistant Enterococcus (VRE) %K rifampicin %I Microbiology Society, %X Introduction: Ireland currently has the highest reported rate in Europe of vancomycin-resistant Enterococcus (VRE) isolated from the bloodstream, but data regarding the prevalence of VRE endocarditis remain scarce. Treatment options for Enterococcus-mediated endocarditis are limited, and therefore daptomycin is commonly used off licence in this setting. Case presentation: A 60-year-old male with end-stage kidney disease (ESKD) presented with VRE bacteraemia secondary to a gangrenous right foot colonized with vancomycin-resistant Enterococcus faecium. Aortic valve endocarditis was confirmed using transoesophageal echocardiography. Treatment was commenced with linezolid and subsequently modified to combination therapy with daptomycin and rifampicin. High-dose daptomycin therapy was employed unsuccessfully and, after 20 days of therapy, daptomycin resistance emerged, which proved fatal. Conclusion: The case was ethically challenging and involved a refusal of amputation and, ultimately, any form of treatment by the patient. In summary, however, daptomycin-resistant VRE bacteraemia complicated by recalcitrant daptomycin-resistant VRE endocarditis proved fatal for this patient. Further evaluation of the efficacy and safety of high-dose daptomycin for the treatment of VRE infective endocarditis is needed. %U https://www.microbiologyresearch.org/content/journal/jmmcr/10.1099/jmmcr.0.000089