Buffart Beverly, Clevenbergh Philippe, Stiuliuc Alina, Raftakis Ioannis, Hing Mony, Miendje Deyi Véronique Yvette, Denis Olivier, Martiny Delphine, Yin Nicolas
Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles-Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium.
Infectious Diseases Department, University Hospital Brugmann, Université Libre de Bruxelles (ULB), 1090 Brussels, Belgium.
Antibiotics (Basel). 2025 Aug 7;14(8):809. doi: 10.3390/antibiotics14080809.
Borderline oxacillin-resistant (BORSA) represents a rare and poorly characterized phenotype of . . Its detection remains challenging, even in modern clinical laboratories. Moreover, there is no consensus on the optimal therapeutic approach, and treatment strategies remain controversial. In this report, we present a rare case of BORSA bacteremia and discuss potential approaches to improve its detection and management.
A 39-year-old woman with systemic lupus erythematosus was admitted for a suspected exacerbation, complicated by multiple serositis and nephritis. She was on chronic treatment with methylprednisolone and hydroxychloroquine. On admission, she was afebrile. Laboratory investigations revealed elevated C-reactive protein and increased D-dimer levels. Later, she developed a septic peripheral venous thrombophlebitis, and treatment was adjusted to amoxicillin-clavulanate. Blood cultures grew , prompting a switch to intravenous oxacillin based on a negative penicillin-binding protein 2a test. A discrepancy in the antimicrobial susceptibility test was observed, with cefoxitin showing susceptibility and oxacillin resistance. Further characterizations were carried out, confirming a BORSA infection. Treatment was switched to linezolid and ciprofloxacin with good recovery.
This case highlights the complexity of managing a patient with an uncommon and poorly documented infection. The lack of data on BORSA infections and the difficulties in detecting and treating them led to a prolonged delay in the appropriate management of this patient.
临界耐苯唑西林（BORSA）代表一种罕见且特征描述不足的……表型。即使在现代临床实验室中，其检测仍具有挑战性。此外，对于最佳治疗方法尚无共识，治疗策略仍存在争议。在本报告中，我们呈现了一例罕见的BORSA菌血症病例，并讨论了改善其检测和管理的潜在方法。
一名39岁的系统性红斑狼疮女性因疑似病情加重入院，并发多发性浆膜炎和肾炎。她正在接受甲泼尼龙和羟氯喹的长期治疗。入院时，她无发热。实验室检查显示C反应蛋白升高，D - 二聚体水平增加。后来，她发展为感染性外周静脉血栓性静脉炎，治疗调整为阿莫西林 - 克拉维酸。血培养生长出……，基于青霉素结合蛋白2a试验阴性促使改用静脉注射苯唑西林。观察到抗菌药物敏感性试验存在差异，头孢西丁显示敏感而苯唑西林耐药。进行了进一步的特征分析，证实为BORSA感染。治疗改为利奈唑胺和环丙沙星，患者恢复良好。
本病例突出了管理一名患有罕见且记录不充分感染患者的复杂性。关于BORSA感染的数据缺乏以及检测和治疗的困难导致该患者的适当管理出现长时间延迟。
