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 49-year-old male was admitted for symptoms of an upper respiratory tract infection with a nonhealing diabetic foot wound secondary to longstanding DM with diabetic neuropathy and HTN. Blood cultures revealed MSSA on day 1, and ceftriaxone 2 g every 24 h was initiated on day 2 with clearance observed on day 3. X-rays suggested osteomyelitis, and a below the knee amputation was performed on day 5. Postamputation, ceftriaxone 2 g every 24 h was continued for 4 weeks. The patient was readmitted twice the following month, once for a fall that caused bleeding at the site of the amputation and once for debridement, but cultures did not reveal any MSSA, and no MSSA BSI-related recurrence was noted on either admission.