Protracted and recurrent methicillin-resistant Staphylococcus aureus bacteremia despite defervescence with vancomycin therapy

Scandinavian Journal of Infectious Diseases
R KhatibH Aljundi

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia persisted for 46 days in a 63-year-old patient and recurred over 98 days in a 79-year-old patient, despite vancomycin therapy. Although the fever resolved, patient 1 developed a spinal epidural abscess 38 days after beginning therapy and patient 2 sustained multiple relapses. A time-kill study demonstrated a reduced vancomycin killing rate in both isolates when compared to the killing rate of a control MRSA strain. The bacteremia persisted after increasing the vancomycin dose to achieve trough levels of 15-20 micrograms; it cleared after adding gentamicin. These cases illustrate that MRSA bacteremia may persist during vancomycin therapy despite resolution of fever and may lead to delayed complications, and that adding gentamicin may be necessary for ultimate clearance of the bacteremia.

References

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Citations

Feb 24, 2007·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·J GómezM Valdés
Jul 17, 2004·Southern Medical Journal·Michael S Gelfand, Kerry O Cleveland
Jan 7, 2004·American Journal of Surgery·Joseph S SolomkinSamuel Eric Wilson
Feb 13, 2001·The Journal of Hospital Infection·B Rubinovitch, D Pittet
Dec 13, 2005·Scandinavian Journal of Infectious Diseases·Riad KhatibSajjad Saeed
May 3, 2007·Journal of Environmental Science and Health. Part. B, Pesticides, Food Contaminants, and Agricultural Wastes·Anushree MalikSantosh Satya
Jan 16, 2004·Scandinavian Journal of Infectious Diseases·Leonard B JohnsonRiad Khatib

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