title: Methicillin-resistant Staphylococcus aureus epidural abscess treated with ceftaroline fosamil salvage therapy.
abstract: OBJECTIVE
  A case of a patient who received ceftaroline fosamil as salvage therapy for a methicillin-resistant Staphylococcus aureus (MRSA) epidural abscess is reported.
  
  
  CONCLUSIONS
  A 48-year-old white woman arrived at the emergency department (ED) with an altered mental status. She had been to the ED two days prior with complaints of sudden-onset and worsening neck pain. She had a history of compacted disks in her neck secondary to a motor vehicle accident that occurred three years prior but that did not require surgical intervention. Computed tomography and magnetic resonance imaging scans confirmed an epidural abscess with wound cultures growing MRSA. The admitting physician indicated that the patient was severely septic. Acyclovir, ceftriaxone, and vancomycin were initiated for empirical treatment due to suspected meningitis. Paired blood cultures also continued to grow MRSA in four of four bottles collected four days after admission. This indicated that antimicrobial therapy was not successfully eradicating the MRSA found in the blood and the patient's clinical status was deteriorating. Ceftaroline was used as salvage therapy, resulting in rapid clearance of MRSA from the blood and the patient becoming afebrile in 24 hours. Blood culture tests on hospital day 11-one day after ceftaroline initiation-were clear of MRSA. The patient was discharged to a long-term-care facility and ordered ceftaroline fosamil 600 mg i.v. every 12 hours for four weeks.
  
  
  CONCLUSIONS
  A MRSA epidural abscess in a 48-year-old woman was successfully treated with ceftaroline fosamil 600 mg every 12 hours as salvage therapy.
authors.affiliation: John Bucheit, Pharm.D., is Pharmacy Practice Resident, Pharmacy Department; Rebeccah Collins, Pharm.D., is Residency Director, Antimicrobial Stewardship; and Prajwol Joshi, M.D., is Infectious Disease Physician, Infectious Disease, Memorial Regional Medical Center, Mechanicsville, VA.
authors.forename: John
authors.initials: J
authors.lastname: Bucheit
authors.forename: Rebeccah
authors.initials: R
authors.lastname: Collins
authors.forename: Prajwol
authors.initials: P
authors.lastname: Joshi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004632:Emergency Medical Services; D020802:Epidural Abscess / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D007796:Laminectomy; D008134:Long-Term Care; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D016879:Salvage Therapy / Q000379:methods*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D013921:Thrombocytopenia / Q000209:etiology; D014057:Tomography, X-Ray Computed; D000097583:Ceftaroline
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000097583:Ceftaroline