title: Vertebral osteomyelitis caused by vancomycin-tolerant methicillin-resistant Staphylococcus aureus bacteremia: Experience with teicoplanin plus fosfomycin combination therapy.
abstract: An 85-year-old female presented with fever and consciousness disturbance for 3 days. The patient's blood culture subsequently revealed persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia despite the administration of vancomycin or teicoplanin monotherapy. Gallium inflammation scan and magnetic resonance image of the spine disclosed osteomyelitis and discitis at the level of L4-5. Surgical debridement was not feasible in this debilitated patient. Because of the creeping minimal inhibitory concentration of vancomycin of the causative isolate (1.5 μg/mL) and clinical failure with glycopeptide monotherapy, we changed the antibiotic therapy to a fosfomycin and teicoplanin combination therapy. The patient showed improved clinical response in terms of her enhanced consciousness as well as subsidence of persisted bacteremia. Despite the potential side effects of fosfomycin (such as diarrhea and hypernatremia), it combined with a glycopeptide may be an alternative therapy for invasive refractory MRSA infections.
authors.affiliation: Section of Infectious Disease, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taiwan. Electronic address: 89425@wanfang.gov.tw.
authors.forename: Wen-Sen
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Section of Nephrology, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taiwan.
authors.forename: Yen-Chuo
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Section of Nephrology, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taiwan.
authors.forename: Hung-Ping
authors.initials: HP
authors.lastname: Chen
authors.affiliation: Section of Nephrology, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taiwan.
authors.forename: Tso-Hsiao
authors.initials: TH
authors.lastname: Chen
authors.affiliation: Section of Nephrology, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taiwan. Electronic address: 89425@wanfang.gov.tw.
authors.forename: Chung-Yi
authors.initials: CY
authors.lastname: Cheng
mesh_terms: D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D004338:Drug Combinations; D005260:Female; D005578:Fosfomycin / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology*; D013131:Spine / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D013203:Staphylococcal Infections / Q000188:drug therapy*; D017334:Teicoplanin / Q000627:therapeutic use*; D014640:Vancomycin / Q000627:therapeutic use; D020713:Vancomycin Resistance
chemical_list: D004338:Drug Combinations; D005578:Fosfomycin; D017334:Teicoplanin; D014640:Vancomycin
keywords: Fosfomycin; Glycopeptide; Methicillin-resistant Staphylococcus aureus; Osteomyelitis