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 40-year-old female admitted for a BSI with an abscess on her left arm was hospitalized 2 days prior for new-onset DM. Blood cultures drawn on the day of discharge from the previous hospitalization grew MSSA. New blood cultures were obtained, and she was initiated on vancomycin therapy. On day 2, cultures revealed MSSA; vancomycin was discontinued, and oxacillin 2 g every 4 h was prescribed. On day 5, oxacillin was discontinued and she was discharged with ceftriaxone 2 g every 24 h to complete 4 weeks of therapy.