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.
A 35-year-old female was admitted for fever with swelling and pain at the site of the peripherally inserted central catheter (PICC) in her left arm. She had a PMH of gastroparesis with multiple abdominal surgeries and was reliant on total parenteral nutrition. Blood cultures revealed MSSA, and her PICC was removed for 48 h before a new one was placed. She received ceftriaxone 1 g every 24 h on days 1–3. Ceftriaxone was switched to oxacillin 2 g every 6 h on day 4. She was changed back to ceftriaxone 2 g every 24 h on day 12, then discharged to a long-term acute care (LTAC) facility on day 23. She continued ceftriaxone at LTAC for 8 additional days.