Journal List > Infect Chemother > v.41(6) > 1075497

Kim, Kim, Jang, Kang, Kim, Jang, Park, Kim, Kim, and Oh: Alternating Linezolid-Vancomycin Therapy for Persistent Endovascular Methicillin-resistant Staphylococcus aureus Infection: A Case Report

Abstract

Persistent Staphylococcus aureus bacteremia is frequently defined as bacteremia persisting for ≥7 days despite proper antibiotic therapy. Its treatment includes removal of all infection foci and proper antibiotic therapy. Vancomycin remains the antibiotic of choice in MRSA bacteremia. Alternative agents, linezolid or daptomycin, are available, but a consensus regarding management of persistent MRSA bacteremia on vancomycin failure is still lacking. We report a case of a 60-year-old male who received thoracoabdominal aorta replacement operation due to dissecting aneurysm of the ascending and descending aorta. Surgical site infection and bacteremia caused by MRSA occured, and wound debridement operations were performed. The patient was treated with vancomycin in therapeutic doses but MRSA bacteremia persisted for 168 days in a row. Although the inserted aortic graft was the most probable source of persistent bacteremia, surgical removal was impossible. Linezolid was administered as an alternative antibiotic but had to be discontinued from time to time due to thrombocytopenia induced by this agent. In the end, MRSA bacteremia was successfully managed by alternating vancomycin-linezolid therapy.

Figures and Tables

Figure 1
The clinical course of the patient during linezolid therapy. The patient received linezolid as an alternative treatment for MRSA bacteremia that persisted despite treatment with vancomycin in therapeutic doses. Thrombocytopenia developed within 14 days of linezolid therapy and linezolid was discontinued. After discontinuation of linezolid, the thrombocytopenia recovered spontaneously in about 10-14 days.
*post-operative days
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Table 1
Antibiogram of Isolated Staphylococcus aureus
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Abbreviations: POD, post operative day; S, sensitive; R, resistant

*S. aureus isolated from the wound after POD #18 showed the same antibiogram

S. aureus isolated from blood cultures after POD #186 showed the same antibiogram

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