2026 年 52 巻 7 号 p. 450-455
We report a successful case of treatment with daptomycin (DAP) in an extremely low-birth-weight infant presenting with persistent bacteremia caused by methicillin-resistant Staphylococcus epidermidis (MRSE).
The case involved a male infant diagnosed with twin-to-twin transfusion syndrome, born via emergency cesarean section at 26 weeks of gestation with a birth weight of 814 g.
On the ninth day of life, the infant developed an elevated inflammatory response. After submitting various cultures, cefazolin and amikacin were started. Blood cultures taken the same day identified MRSE. On Day 11, antibiotics were changed to vancomycin (VCM) and meropenem. On Days 13 and 14, the peripherally inserted central catheters (PICC) in both upper limbs were replaced. VCM administration continued until Day 24, but blood cultures remained positive.
On Day 24, antimicrobial therapy was changed to DAP (10 mg/kg/day), which resulted in improvement of the inflammatory response and general condition. The PICC were removed on Days 31 and 33, respectively. Blood cultures were negative by Day 33. DAP was administered for 24 days without adverse effects such as elevated CPK or eosinophilia.
The use of DAP in extremely low-birth-weight infants is extremely rare both domestically and internationally. Moreover, its efficacy and safety are still unclear. This case suggests that DAP can be a useful option for persistent MRSE bacteremia in neonates where catheter removal is difficult.
