Koton Yael, Or Zafrir, Bisharat Naiel
Department of Medicine D, Emek Medical Center, Afula.
Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa.
Infect Dis Rep. 2017 May 31;9(2):7008. doi: 10.4081/idr.2017.7008.
Persistent methicillin-resistant (MRSA) bacteremia is associated with significant risk of mortality, especially when it occurs while on appropriate antimicrobial therapy. We herein describe an unusual case of a patient with prosthetic aortic tissue valve, who suffered from central venous catheter related MRSA bacteremia with septic thrombus formation in the superior vena cava. MRSA bacteremia persisted despite removal of the catheter and appropriate antimicrobial therapy including vancomycin, rifampin, and daptomycin. Subsequently, the MRSA strain exhibited resistance to vancomycin, rifampin and daptomycin. Eventually, salvage combination therapy with high dose daptomycin and trimethoprim-sulfamethoxazole was successful and achieved clearance of MRSA bacteremia. The case illustrates the growing complexity of treating MRSA infections.
持续性耐甲氧西林金黄色葡萄球菌（MRSA）菌血症与显著的死亡风险相关，尤其是在接受适当抗菌治疗期间发生时。我们在此描述了一例不寻常的病例，该患者植入了人工主动脉组织瓣膜，患有与中心静脉导管相关的MRSA菌血症，并在上腔静脉形成了感染性血栓。尽管拔除了导管并给予了包括万古霉素、利福平及达托霉素在内的适当抗菌治疗，MRSA菌血症仍持续存在。随后，该MRSA菌株对万古霉素、利福平及达托霉素均表现出耐药性。最终，高剂量达托霉素与甲氧苄啶-磺胺甲恶唑的挽救性联合治疗取得成功，实现了MRSA菌血症的清除。该病例说明了治疗MRSA感染的复杂性日益增加。
