Origin of de novo daptomycin non susceptible enterococci

摘要

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.