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 66-year-old male with PMH including DM and hypertension (HTN) was admitted for septicemia secondary to cellulitis of the left great toe. He received vancomycin until day 3, when blood cultures revealed MSSA. Oxacillin 2 g every 4 h was administered from hospital days 4 through 7, then oxacillin was changed to ceftriaxone 2 g every 24 h for 4 weeks of therapy.