title: Fatal persistent methicillin-resistant Staphylococcus aureus bacteremia and vascular graft infections complicated with the formation of multiple abscesses despite aggressive medical therapy.
abstract: A 40-year-old man underwent ascending aorta replacement for an acute type A aortic dissection. After the operations, methicillin-resistant Staphylococcus aureus was identified in sputum and blood cultures. Although anti-methicillin-resistant Staphylococcus aureus drugs were administered, most of the intermittent blood cultures remained positive. The focus of methicillin-resistant Staphylococcus aureus infection was not evident in the early stages, and no specific symptoms such as abscess or endocarditis were observed. However, abscesses in the brain, mediastinum and spleen were found 3 years after the operation. The minimum inhibitory concentration of vancomycin gradually increased from 1 to 4 µg/mL during the course of treatment. This case provides evidence for a potential role of combination therapy.
authors.affiliation: Division of Cardiovascular, Respiratory and General Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Shiba
authors.affiliation: Division of General Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Yanai
authors.affiliation: Division of Cardiovascular, Respiratory and General Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Maeda
authors.affiliation: Division of Cardiovascular, Respiratory and General Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Motomi
authors.initials: M
authors.lastname: Shiono
keywords: Methicillin-resistant Staphylococcus aureus; aortic dissection; bacteremia; vascular prosthesis