A 64-year-old female admitted for shortness of breath, weakness, and fatigue with a PMH of HTN, DM, heart failure, atrial fibrillation, and end-stage renal disease (ESRD) had positive MSSA blood cultures from admission. A definitive source for the MSSA BSI was not determined but assumed to be foreign body material (tunneled dialysis catheter, Foley catheter, and implantable cardiac device). She was initiated on ceftriaxone 2 g every 24 h on day 3 and cultures cleared on day 8. She received 4 weeks of ceftriaxone (25 days inpatient and 3 days outpatient).
A 41-year-old male with PMH of uncontrolled DM was admitted for cellulitis of the left lower leg. He continued to worsen despite 5 days of outpatient therapy with clindamycin. Foot ulcer and blood cultures from hospital day 1 grew MSSA; MRI was not indicative of osteomyelitis or septic arthritis. Clindamycin was discontinued, and oxacillin 2 g every 4 h was initiated on day 5. On day 7, oxacillin was changed to ceftriaxone 2 g every 24 h for 4 weeks of outpatient therapy.