Infect Chemother.  2009 Dec;41(6):371-374. 10.3947/ic.2009.41.6.371.

Alternating Linezolid-Vancomycin Therapy for Persistent Endovascular Methicillin-resistant Staphylococcus aureus Infection: A Case Report

• Kim NH
• Kim M
• Jang ES
• Kang YM
• Kim G
• Jang HC
• Park WB
• Kim EC
• Kim NJ
• Oh MD

• KMID: 2285045
• DOI: http://doi.org/10.3947/ic.2009.41.6.371

Abstract

Persistent Staphylococcus aureus bacteremia is frequently defined as bacteremia persisting for > or =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.

Keyword

Bacteremia; Methicillin-Resistant Staphylococcus aureus; Linezolid; Vancomycin; Treatment failure

MeSH Terms

Acetamides
Aneurysm, Dissecting
Aorta
Aorta, Thoracic
Bacteremia
Consensus
Daptomycin
Debridement
Humans
Linezolid
Male
Methicillin Resistance
Methicillin-Resistant Staphylococcus aureus
Middle Aged
Oxazolidinones
Staphylococcus aureus
Thrombocytopenia
Transplants
Treatment Failure
Vancomycin
Acetamides
Daptomycin
Oxazolidinones
Vancomycin

Figure

• 

  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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