Verdecia Jorge, Hernandez Jarelys, Izzo Christopher, Sottile Elisa, Isache Carmen
Department of Internal Medicine, University of Florida Health at Jacksonville, Jacksonville, Florida, USA.
BMJ Case Rep. 2019 Aug 28;12(8):e229114. doi: 10.1136/bcr-2018-229114.
A 61-year-old Caucasian woman presented to the emergency room complaining of left-sided chest pain and altered mentation for 3 days. Her medical history included liver cirrhosis and coronary artery disease. On admission, she was found to have methicillin-resistant (MRSA) bacteraemia. Due to a decline in mental status, a lumbar puncture was performed and cerebrospinal fluid cultures grew MRSA. She was treated initially with vancomycin. Ceftaroline was later added, due to the high burden of disease and difficulty in clearing her infection. After initiation of ceftaroline, bacteraemia cleared and mental status improved, however, she developed haemolytic anaemia. Ceftaroline was stopped and vancomycin continued. Staphylococcal meningitis is a rare occurrence, estimated at a rate of only 1%-10% of all bacterial meningitis cases. Ceftaroline seems to be a suitable option for disseminated MRSA infection, including MRSA meningitis, when the clinical response to vancomycin is inadequate. Further studies are warranted in order to establish adequate dosing while avoiding adverse effects.
一名61岁的白种女性因左侧胸痛和意识改变3天就诊于急诊室。她的病史包括肝硬化和冠状动脉疾病。入院时，发现她患有耐甲氧西林金黄色葡萄球菌（MRSA）菌血症。由于精神状态下降，进行了腰椎穿刺，脑脊液培养出MRSA。她最初接受万古霉素治疗。由于疾病负担重且感染难以清除，后来加用了头孢洛林。开始使用头孢洛林后，菌血症清除，精神状态改善，但她出现了溶血性贫血。停用头孢洛林，继续使用万古霉素。葡萄球菌性脑膜炎很少见，估计仅占所有细菌性脑膜炎病例的1%-10%。当对万古霉素的临床反应不足时，头孢洛林似乎是播散性MRSA感染（包括MRSA脑膜炎）的合适选择。有必要进行进一步研究以确定合适的剂量并避免不良反应。
