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Journal of Intensive Care Medicine
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0885066608320849v1
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Article

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

Jason Schairer, MD1, Abdul Ghani Sankri-Tarbichi, MD, MSc2*, Marilynn R. Fairfax, MD, Ph.D.3, Hossein Salimnia, Ph.D.3, and Jorge A. Guzman, MD4

1 Dept of Medicine
2 Division of Pulmonary/Critical Care and Sleep Medicine
3 DMC University Laboratories and Department of Pathology
4 Wayne State University School of Medicine

* To whom correspondence should be addressed. E-mail: atarbich{at}med.wayne.edu (Tarbichi's email).


  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-yearold 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.

First published on August 12, 2008, doi:10.1177/0885066608320849

Journal of Intensive Care Medicine 2008;23:338.

A more recent version of this article appeared on September 1, 2008

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