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 57-year-old male was admitted for sepsis secondary to septic arthritis of the right hip and left shoulder. He had a PMH of rheumatoid arthritis and was receiving long-term immunosuppressive therapy with prednisone. Blood cultures on admission were positive for MSSA. On day 3, the left shoulder was irrigated and debrided. Ceftriaxone 2 g every 24 h was initiated on day 6 for 6 weeks of therapy from first negative blood culture. An MRI revealed erosive changes along both sides of the right hip joint, and an antibiotic spacer was placed on hospital day 7.