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Staphylococcus aureus1, 2, 3

  • One of the most common pathogens causing community-acquired and nosocomial infections
  • Has rapidly developed resistance to many antibiotics:

Daptomycin 2

  • Bactericidal cyclic lipopeptide antibiotic
  • Possesses negative charge which attracts calcium to form cationic complex
  • Interacts with negatively charged phospholipid heads on bacterial cell membranes, leading to membrane depolarization and cell death

Daptomycin non-susceptible (DNS) S. aureus 2, 4, 5

  • Extremely rare - About 60 clinical cases reported
  • Defined by an MIC greater than 1 mcg/mL
  • Potential mechanisms include:

– Changes in cell membrane and cell wall structure alter daptomycin’s permeability2

  • Overexpression and dysregulation of dltA transcription increases D-alanylated teichoic acid content in the cell wall
  • mprF mutation leads to partially neutral charge of cell membrane

– Vancomycin intermediate S. aureus (VISA) and vancomycin resistant S. aureus (VRSA) may predispose patients to develop DNS S. aureus2

  • Have seen increased resistance with lower doses4, 5

– 4 to 6 mg/kg/day has higher rates of DNS S. aureus

– Experts recommend doses ≥ 8mg/kg/day especially for bacteremia

Publication Date



Daptomycin Non-Susceptible MRSA Bacteremia: A Case Report, Thomas Jefferson University Hospital, Department of Pharmacy


Pharmacy and Pharmaceutical Sciences


Poster presented at: ASHP Clinical Midyear Meeting in New Orleans LA

Daptomycin Non-Susceptible MRSA Bacteremia: A Case Report