Background:Evidence supporting beta-lactam plus vancomycin synergy for
methicillin-resistant Staphylococcus aureus (MRSA)
continues to grow. Current in vivo evidence demonstrates
that combination therapy is associated with shorter time to blood
sterilization than vancomycin monotherapy. However, this combination has not
been reported as salvage therapy for persistent MRSA bacteremia.Case report:We report a case of an 81-year-old male who was successfully treated with
vancomycin plus nafcillin after failing vancomycin monotherapy, daptomycin
monotherapy, and daptomycin plus gentamicin combination therapy. The patient
originally presented with sepsis from a suspected urinary tract infection.
Blood cultures drawn on days 1, 3, 5, 15, 19, 23, and 28 remained positive
for MRSA despite multiple antimicrobial therapy changes. On day 29, therapy
was changed to vancomycin plus nafcillin. Blood cultures drawn on day 32
remained negative. After 11 days, nafcillin was changed to
piperacillin–tazobactam due to an infected decubitus ulcer. The combination
was continued for 42 days after achieving blood sterility, 71 days after the
patient originally presented. Evidence regarding salvage therapy for
persistent bacteremia is sparse and is limited to case reports and case
series.Conclusion:This case report supports that vancomycin plus an anti-staphylococcal
beta-lactam combination should be further studied as salvage therapy for
persistent MRSA bacteremia.
The rise of the opioid crisis has fueled a rise in new hepatitis C infection, and a rise in new HIV infection is expected to follow. Injection drug use has directly contributed to the epidemic and continues to remain a risk factor. Men who have sex with men remains a significant risk factor for HIV acquisition as well. Progress has been made in the battle against HIV and, to a lesser extent, hepatitis C, but much more can be done. Limited data on co-infection with HIV/HCV are currently available for this at-risk region, but it is clear that Appalachia is highly vulnerable to co-infection outbreaks. A multipronged approach that includes advances in assessment of co-infection and education for both patients and clinicians can help to recognize, manage, and ideally prevent these illnesses.
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