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 68-year-old female had positive blood cultures for MSSA and a paraspinal abscess, which was subsequently drained, and a TEE displayed a large vegetation on the right atrial junction. She was initially treated with oxacillin 2 g every 4 h from days 5 to 12. Negative blood cultures were obtained on day 9. On discharge (day 13), ceftriaxone 2 g every 24 h was initiated for completion of 6 weeks of therapy from first negative blood culture. Follow-up computed tomography (CT) scans showed that the paraspinal abscess resolved.