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Methicillin-Resistant Staphylococcus aureus Infection With Intermediate Sensitivity to Vancomycin: A Case Report and Literature Review

Department of Medicine DMC University Laboratories, Wayne State University-School of Medicine, Harper University Hospital, Detroit, Michigan

Abdul Ghani Sankri-Tarbichi, MD, MSc

Department of Medicine DMC University Laboratories, Wayne State University-School of Medicine, Harper University Hospital, Detroit, Michigan, atarbich{at}med.wayne.edu

Marilynn R. Fairfax, MD, PhD

Department of Pathology, Wayne State University-School of Medicine, Harper University Hospital, Detroit, Michigan

Hossein Salimnia, PhD

Department of Pathology Wayne State University-School of Medicine, Harper University Hospital, Detroit, Michigan

Jorge A. Guzman, MD

Department of Medicine DMC University Laboratories, Wayne State University-School of Medicine, Harper University Hospital, Detroit, Michigan

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 2 µg/mL (susceptible) to 4 µg/mL (intermediate). The antibiotic was changed to daptomycin. Subsequent blood cultures were negative and sepsis resolved.

Key Words: methicillin • resistance • Staphylococcus aureus • vancomycin

This version was published on September 1, 2008

Journal of Intensive Care Medicine, Vol. 23, No. 5, 338-341 (2008)
DOI: 10.1177/0885066608320849


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