Unsuccessful treatment of methicillin-resistant Staphylococcus aureus endocarditis with dalbavancin

What is known and objectiveLimited evidence describes dalbavancin use in infective endocarditis (IE). Case descriptionA 27-year-old pregnant female received 4weeks of dalbavancin for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia and tricuspid valve IE after conventional therapy was no longer an option due to non-compliance. Despite having a smaller cardiac vegetation following dalbavancin, she was bacteraemic <2weeks later with vancomycin-intermediate (VISA) and telavancin-non-susceptible S.aureus. What is new and conclusionThis is the first report of unsuccessful IE treatment with dalbavancin. Blood cultures grew VISA and lipoglycopeptide-non-susceptible S.aureus <2weeks following dalbavancin. Both outcomes raise concerns about using dalbavancin for IE.