Ebot James, Freeman W D, Wharen Robert, Diaz Mark Anthony, Libertin Claudia
Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
Department of Infectious Disease, Mayo Clinic, Jacksonville, Florida, USA.
Case Rep Infect Dis. 2019 Jan 30;2019:7413089. doi: 10.1155/2019/7413089. eCollection 2019.
Spinal epidural abscess caused by MRSA, a life-threatening organism resistant to methicillin and other antibiotics, is a rare but important infectious pathology due to its potential damage to the spinal cord. We present the case of a 74-year-old man who hematogenously seeded his entire epidural spinal canal from C1 to sacrum with MRSA bacteria and remained infected even after maximal treatment with vancomycin and daptomycin. Ceftaroline, a new 5th generation antibiotic with recently described clearance of widespread MRSA infection in epidural complex spine infections, was added to vancomycin as dual therapy for his MRSA infection. A 74-year-old diabetic man with prior right total knee arthroplasty and MRSA infection presented with persistent bacteremia and sepsis. He was transferred to our academic center after diagnosis of entire spine epidural abscesses from C1 to sacral levels with midthoracic MRI T2 hyperintensities of the vertebral bodies and disc concerning for osteomyelitis and discitis. Despite surgery and IV vancomycin with MIC of 1, suggesting extreme susceptibility, the patient's blood cultures remained persistently bacteremic at day 5 of treatment. After 48 hours of dual antibiotic therapy with vancomycin and ceftaroline, his blood cultures came back showing no growth. The patient's outcome was unfavorable due to the advanced nature of his infection and multiple comorbidities, but his negative blood cultures after the addition of ceftaroline to his regime require further investigation into this dual therapy. Randomized controlled trials of 5th generation or combinatorial antibiotics should be considered for this disease.
由甲氧西林耐药金黄色葡萄球菌（MRSA）引起的脊柱硬膜外脓肿是一种罕见但重要的感染性病理状况，该病菌对甲氧西林和其他抗生素耐药，会危及生命，因其可能对脊髓造成损害。我们报告了一例74岁男性病例，其通过血行播散使整个硬膜外椎管从C1至骶骨均被MRSA细菌感染，即便在接受万古霉素和达托霉素的最大剂量治疗后仍持续感染。头孢洛林是一种新型五代抗生素，最近有报道称其可清除硬膜外复杂脊柱感染中广泛存在的MRSA感染，遂将其与万古霉素联合用于该患者的MRSA感染治疗。一名74岁患有糖尿病的男性，既往有右全膝关节置换术及MRSA感染史，出现持续性菌血症和脓毒症。在通过胸部MRI发现椎体和椎间盘T2高信号，怀疑为骨髓炎和椎间盘炎，从而诊断为从C1至骶骨水平的全脊柱硬膜外脓肿后，他被转至我们的学术中心。尽管进行了手术并静脉输注了最低抑菌浓度为1（提示极度敏感）的万古霉素，但患者在治疗第5天时血培养仍持续呈菌血症。在接受万古霉素和头孢洛林联合抗生素治疗48小时后，其血培养结果显示无细菌生长。由于患者感染病情严重且合并多种疾病，其预后不佳，但在治疗方案中加入头孢洛林后血培养转阴，这需要对这种联合治疗进行进一步研究。对于这种疾病，应考虑开展五代抗生素或联合抗生素的随机对照试验。
