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Background  Emergence of daptomycin-nonsusceptible (DNS)  Staphylococcus aureus  is a dreadful problem in the treatment of endocarditis. Few current therapeutic agents are effective for treating infections caused by DNS  S. aureus .    Case presentation  We describe the emergence of DNS  S. aureus . in a patient with implantable cardioverter-defibrillator (ICD) device -related endocarditis who was priorily treated with daptomycin. Metastatic dissemination as osteomyelitis further complicated the management of endocarditis. The dilemma was successfully managed by surgical removal of the ICD device and combination antimicrobial therapy with high-dose daptomycin and fosfomycin.    Conclusions  Surgical removal of intracardiac devices remains an important adjunctive measure in the treatment of endocarditis. Our case suggests that combination therapy is more favorable than single-agent therapy for infections caused by DNS  S. aureus .

High-dose daptomycin and fosfomycin treatment of a patient with endocarditis caused by daptomycin-nonsusceptible Staphylococcus aureus: Case report