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World J Clin Infect Dis. May 25, 2015; 5(2): 30-36
Published online May 25, 2015. doi: 10.5495/wjcid.v5.i2.30
Origin of de novo daptomycin non susceptible enterococci
Theodoros Kelesidis
Theodoros Kelesidis, Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
Author contributions: Kelesidis T wrote the paper.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Theodoros Kelesidis, MD, PhD, Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, CHS 37-121, Los Angeles, CA 90095, United States. tkelesidis@mednet.ucla.edu
Telephone: +1-310-8257225 Fax: +1-310-2080140
Received: January 27, 2015
Peer-review started: January 28, 2015
First decision: March 20, 2015
Revised: April 1, 2015
Accepted: April 16, 2015
Article in press: April 20, 2015
Published online: May 25, 2015
Processing time: 112 Days and 15.2 Hours
Abstract

The emergence of daptomycin non-susceptible enterococci (DNSE) poses both treatment and infection control challenges. Clinicians should be vigilant that DNSE may be isolated from patients with or without (de novo DNSE) prior use of daptomycin. Recent epidemiological data suggest the presence of a community reservoir for DNSE which may be associated with environmental, foodborne and agricultural exposures. The mechanisms of nonsusceptibility to daptomycin have not been well characterized and may not parallel those for Staphylococcus aureus. The identification of daptomycin resistance genes in anaerobes, in farm animals and in an ecosystem that has been isolated for million years, suggest that the environmental reservoir for de novo DNSE may be larger than previously thought. Herein, the limited available scientific evidence regarding the possible origin of de novo DNSE is discussed. The current existing evidence is not sufficient to draw firm conclusions on the origin of DNSE. Further studies to determine the mechanisms of de novo daptomycin nonsusceptibility among enterococci are needed.

Keywords: Daptomycin non-susceptible enterococci; Antimicrobial resistance; Environmental reservoir

Core tip: Daptomycin non-susceptible enterococci (DNSE) is an emerging clinical problem and may be isolated from patients with or without (de novo DNSE) prior exposure to daptomycin. Recent epidemiological data suggest the presence of a community reservoir for DNSE which may be associated with environmental, foodborne and agricultural exposures and may be larger than previously thought. Herein, the limited available scientific evidence regarding the possible origin of de novo DNSE is discussed. Further studies to determine the mechanisms of de novo daptomycin nonsusceptibility among enterococci are needed.