Schairer Jason, Sankri-Tarbichi Abdul Ghani, Fairfax Marilynn R, Salimnia Hossein, Guzman Jorge A
Department of Medicine DMC University Laboratories, Wayne State University-School of Medicine, Harper University Hospital, Detroit, Michigan 48201, USA.
J Intensive Care Med. 2008 Sep-Oct;23(5):338-41. doi: 10.1177/0885066608320849.
Staphylococcus aureus is a major cause of bacteremia and endocarditis in adults. Vancomycin is the standard therapy for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Although clinical failure associated with the development of reduced susceptibility to vancomycin during the course of treatment for MRSA bacteremia has been reported infrequently, such an occurrence is very serious. We report a case of 43-year-old woman with of MRSA bacteremia, who relapsed after initial, apparently successful vancomycin treatment and developed left-sided endocarditis and vertebral osteomyelitis. Two weeks into her second admission, the vancomycin minimal inhibitory concentration rose from <or= 2 microg/mL (susceptible) to 4 microg/mL (intermediate). The antibiotic was changed to daptomycin. Subsequent blood cultures were negative and sepsis resolved.
金黄色葡萄球菌是成人菌血症和心内膜炎的主要病因。万古霉素是耐甲氧西林金黄色葡萄球菌（MRSA）菌血症的标准治疗药物。虽然在MRSA菌血症治疗过程中与对万古霉素敏感性降低相关的临床失败情况报道较少，但这种情况非常严重。我们报告一例43岁患有MRSA菌血症的女性病例，该患者在最初看似成功的万古霉素治疗后复发，并发展为左侧心内膜炎和椎体骨髓炎。第二次入院两周后，万古霉素最低抑菌浓度从≤2微克/毫升（敏感）升至4微克/毫升（中介）。抗生素改为达托霉素。随后血培养转阴，脓毒症得到缓解。
