Abstract
Daptomycin is a canonical antibiotic used very commonly in practice for its bactericidal activity against Gram-positive bacteria, including vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, bone infections, skin and soft tissue infections, meningitis, urinary tract infections, and endocarditis. Although daptomycin in conventional doses is usually well tolerated, it is paramount to be aware of the possible adverse effects. Daptomycin is reported to cause an elevation in creatine kinase levels, although frank rhabdomyolysis is rare. An even more infrequent occurrence is the simultaneous development of acute kidney injury and drug-induced liver injury with rhabdomyolysis. Daptomycin and rifampin combination are used for synergistic bactericidal action against MRSA. Still, data on the efficacy and safety of the combination is limited due to a lack of extensive studies. Herein, we present a clinical case of septic arthritis of a prosthetic knee, which resulted in bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA) and subsequently led to infective endocarditis of the aortic valve. The patient was treated with a combination of daptomycin and rifampin, complicated by the development of rhabdomyolysis, acute kidney injury, and drug-induced liver injury. This case highlights the significance of timely recognizing adverse drug effects and identifying risk factors to ensure successful patient outcomes.