Khatib R, Riederer K M, Held M, Aljundi H
Department of Medicine, St John Hospital and Medical Center, Detroit, Michigan, USA.
Scand J Infect Dis. 1995;27(5):529-32. doi: 10.3109/00365549509047061.
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia persisted for 46 days in a 63-year-old patient and recurred over 98 days in a 79-year-old patient, despite vancomycin therapy. Although the fever resolved, patient 1 developed a spinal epidural abscess 38 days after beginning therapy and patient 2 sustained multiple relapses. A time-kill study demonstrated a reduced vancomycin killing rate in both isolates when compared to the killing rate of a control MRSA strain. The bacteremia persisted after increasing the vancomycin dose to achieve trough levels of 15-20 micrograms; it cleared after adding gentamicin. These cases illustrate that MRSA bacteremia may persist during vancomycin therapy despite resolution of fever and may lead to delayed complications, and that adding gentamicin may be necessary for ultimate clearance of the bacteremia.
尽管接受了万古霉素治疗，但一名63岁患者的耐甲氧西林金黄色葡萄球菌（MRSA）菌血症持续了46天，另一名79岁患者的菌血症在98天内复发。虽然发热症状得到缓解，但患者1在开始治疗38天后出现了脊柱硬膜外脓肿，患者2则多次复发。一项时间杀菌研究表明，与对照MRSA菌株的杀菌率相比，两种分离株中万古霉素的杀菌率均降低。将万古霉素剂量增加以达到15 - 20微克的谷浓度后，菌血症仍持续存在；添加庆大霉素后菌血症得以清除。这些病例表明，尽管发热症状得到缓解，但在万古霉素治疗期间MRSA菌血症可能持续存在，并可能导致延迟并发症，且添加庆大霉素可能是最终清除菌血症所必需的。
