The Importance of Early Source Control in Persistent MRSA Bacteremia: A Case Report.

Jack Demirjian, Paul Mathew
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Abstract

Background: Persistent bacteremia, despite the susceptibility of the causative organism to appropriate antimicrobial therapy, presents a major clinical challenge. In such cases, early identifica-tion and control of the infectious source are essential to prevent complications and reduce mortality.

Case presentation: We report the case of a 59-year-old woman with persistent Methicillin-resistant Staphylococcus Aureus (MRSA) bacteremia following spinal surgery. Despite multiple days of in-travenous antibiotic therapy, her blood cultures remained positive for MRSA. A tagged white blood cell (Technetium-99) scan revealed an abscess in the right sacroiliac joint. Surgical drainage of the abscess led to clinical improvement and resolution of bacteremia. Interestingly, cultures of the ab-scess fluid grew Enterococcus faecalis rather than MRSA.

Discussion: This case underscores the importance of early source control in the management of per-sistent bacteremia. Even when the pathogen isolated from the presumed source differs from that in the bloodstream, drainage can play a critical role in resolving systemic infection.

Conclusion: Early source control should be pursued in persistent bacteremia, regardless of initial culture results. Imaging studies may assist in locating occult sources, and successful drainage may contribute to clinical improvement even when the primary bloodstream pathogen is not isolated from the source.

持续性MRSA菌血症早期源头控制的重要性:1例报告。
背景:尽管病原菌对适当的抗菌药物治疗敏感,但持续性菌血症仍然是一个重大的临床挑战。在这种情况下,早期识别和控制传染源对于预防并发症和降低死亡率至关重要。病例介绍:我们报告一例59岁女性脊柱手术后持续耐甲氧西林金黄色葡萄球菌(MRSA)菌血症。尽管多天静脉注射抗生素治疗,她的血培养仍呈MRSA阳性。标记白细胞(锝-99)扫描显示右侧骶髂关节脓肿。手术引流脓肿导致临床改善和菌血症的解决。有趣的是,脓液培养出粪肠球菌而不是MRSA。讨论:本病例强调了在持续性菌血症管理中早期源头控制的重要性。即使从假定来源分离的病原体与血液中的病原体不同,引流也可以在解决全身性感染方面发挥关键作用。结论:无论初始培养结果如何,对于持续性菌血症应进行早期源头控制。影像学检查可以帮助定位隐匿的传染源,即使在原发血流病原体未与传染源分离的情况下,成功引流也可能有助于临床改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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