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 55-year-old male was admitted with severe pain secondary to a fall with a PMH for HTN and advanced alcoholic cirrhosis. Blood cultures on day 1 were positive for MSSA. Oxacillin 2 g every 4 h was given on days 3–12. The patient achieved MC but failed to achieve CC (WBCs did not normalize within 7 days). On discharge (day 12), he was switched from oxacillin to ceftriaxone 2 g every 24 h. The patient died from liver disease complications 7 days after discharge.