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 35-year-old female with PMH of invasive breast carcinoma with reported tenderness around her chemotherapy port for 1 week was admitted for Gram-positive BSI. The chemotherapy port was removed on day 2 and cultured MSSA. Vancomycin was discontinued in favor of oxacillin 2 g every 4 h until day 5, when oxacillin was discontinued, and she was discharged on 2 weeks of ceftriaxone 2 g every 24 h.