A 24-year-old male with PMH of testicular cancer and recent chemotherapy was admitted from an OSH with fever and given cefepime. On day 2, blood and sputum cultures became positive for MSSA, and cefepime was de-escalated to oxacillin 2 g every 4 h. A chest CT displayed cavitary lesions determined to be caused by MSSA. It was suspected that the MSSA BSI was due to septic emboli from a central line infection, and his chemotherapy port was removed. On day 8, oxacillin was discontinued, and he was initiated on ceftriaxone 2 g every 24 h. He was discharged on day 10 to complete 4 weeks of therapy. Nine days after discharge, he was readmitted with progressive shortness of breath, fever, chills, and night sweats. A pleural fluid culture yielded MSSA, so he received ceftriaxone on days 1–4 and oxacillin on days 4–7. He was discharged on ceftriaxone therapy to complete the 4 weeks.
A 74-year-old male admitted for altered mental status from an outside hospital (OSH) had a past medical history (PMH) of diabetes mellitus (DM), diabetic retinopathy, and atrial fibrillation. Blood and urine cultures revealed MSSA, and treatment was de-escalated from vancomycin to ceftriaxone 2 g every 24 h on day 3. Transesophageal echocardiogram (TEE) revealed no vegetations, but an epidural abscess was identified on day 4. Magnetic resonance imaging (MRI) revealed septic brain emboli. He was discharged on hospital day 44, and ceftriaxone therapy was continued for 8 additional weeks.