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 47-year-old male admitted for MSSA septicemia secondary to a laceration repair on the back of the head 9 days prior had positive surgical site and blood cultures with MSSA. Oxacillin 2 g every 4 h was initiated on day 4. Echocardiogram was negative for vegetations, and on day 11, antimicrobial therapy was switched to ceftriaxone 2 g every 24 h for 6 weeks of therapy.