title: Methicillin-resistant Staphylococcus aureus infection with intermediate sensitivity to vancomycin: a case report and literature review.
abstract: Staphylococcus aureus is a major cause of bacteremia and endocarditis in adults. Vancomycin is the standard therapy for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Although clinical failure associated with the development of reduced susceptibility to vancomycin during the course of treatment for MRSA bacteremia has been reported infrequently, such an occurrence is very serious. We report a case of 43-year-old woman with of MRSA bacteremia, who relapsed after initial, apparently successful vancomycin treatment and developed left-sided endocarditis and vertebral osteomyelitis. Two weeks into her second admission, the vancomycin minimal inhibitory concentration rose from <or= 2 microg/mL (susceptible) to 4 microg/mL (intermediate). The antibiotic was changed to daptomycin. Subsequent blood cultures were negative and sepsis resolved.
authors.affiliation: Department of Medicine DMC University Laboratories, Wayne State University-School of Medicine, Harper University Hospital, Detroit, Michigan 48201, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Schairer
authors.forename: Abdul Ghani
authors.initials: AG
authors.lastname: Sankri-Tarbichi
authors.forename: Marilynn R
authors.initials: MR
authors.lastname: Fairfax
authors.forename: Hossein
authors.initials: H
authors.lastname: Salimnia
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Guzman
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017576:Daptomycin / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy*; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin