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 64-year-old female admitted for shortness of breath, weakness, and fatigue with a PMH of HTN, DM, heart failure, atrial fibrillation, and end-stage renal disease (ESRD) had positive MSSA blood cultures from admission. A definitive source for the MSSA BSI was not determined but assumed to be foreign body material (tunneled dialysis catheter, Foley catheter, and implantable cardiac device). She was initiated on ceftriaxone 2 g every 24 h on day 3 and cultures cleared on day 8. She received 4 weeks of ceftriaxone (25 days inpatient and 3 days outpatient).