Ampicillin and Daptomycin Combination Therapy for Enterococcus Faecalis Endocarditis After Renal Transplantation: A Case Report and Review

Author(s): Fernando Baires, Erin Arias, María José Díaz Ramos, Cesar Burgos, Guillermo Lopez, Juan S Llompart, Jana Radwanski, Tywaun Tillman, Fernando Valerio-Pascua, Anupamjeet Kaur Sekhon, Jarmanjeet Singh, Chetan Jinadatha, Miguel Sierra-Hoffman, Mark L Stevens

Historically, the conventional treatment for enterococcal endocarditis (EE) has been combination antibiotic therapy, as it has proven to be more effective than monotherapy. A novel approach using dual beta-lactam therapy, which combines ampicillin and ceftriaxone, emerged as an equally effective alternative to the traditional combination therapy using aminoglycosides. One key advantage of this regimen is that it avoids the nephrotoxicity associated with aminoglycosides, making it the first aminoglycoside-sparing combination. This innovative treatment approach has gained widespread acceptance worldwide. The incidence of EE is rising, particularly among elderly individuals, those with comorbidities, and patients with healthcare-associated infections. It is now the leading cause of infective endocarditis in kidney transplant recipients and patients who have undergone transcatheter aortic valve implantation (TAVI). Additionally, it is the second most common cause of endocarditis in hemodialysis patients. Given these trends, it is important to explore alternative treatment options that do not involve the use of aminoglycosides. In this report, we present a case of a renal transplant patient who developed Enterococcus faecalis endocarditis that was successfully treated with an aminoglycoside sparing regimen of ampicillin and daptomycin. This case highlights the potential effectiveness of this combination therapy and paves the way for future research into this innovative approach. In conclusion, the treatment landscape for EE has evolved with the introduction of new aminoglycoside sparing combinations. Further research is needed to fully understand the potential benefits and limitations of these alternative therapies and to establish evidence-based guidelines for the management of EE.