Daptomycin resistant Enterococcus faecalis has a mutation in liaX, which encodes a surface protein that inhibits the LiaFSR systems and cell membrane remodeling

The emergence of daptomycin (DAP) resistant Enterococcus species has increased worldwide, but the mechanisms for DAP resistance are not fully understood. We report a case of DAP resistant Enterococcus faecalis, from a clinical sample of a patient with diabetic ulcers, after DAP therapy. Whole-genome sequencing analysis revealed that the isolate had a loss-of-function point mutation within liaX encoding DAP-sensing surface protein, which inhibits the LiaFSR systems and cell membrane remodeling. This is the first case report of a clinical DAP resistant E. faecalis with a mutation in liaX.