Vertebral osteomyelitis caused by vancomycin-tolerant methicillin-resistant Staphylococcus aureus bacteremia: Experience with teicoplanin plus fosfomycin combination therapy

Wen Sen Lee, Yen Chuo Chen, Hung Ping Chen, Tso Hsiao Chen, Chung Yi Cheng

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

An 85-year-old female presented with fever and consciousness disturbance for 3 days. The patient's blood culture subsequently revealed persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia despite the administration of vancomycin or teicoplanin monotherapy. Gallium inflammation scan and magnetic resonance image of the spine disclosed osteomyelitis and discitis at the level of L4-5. Surgical debridement was not feasible in this debilitated patient. Because of the creeping minimal inhibitory concentration of vancomycin of the causative isolate (1.5 μg/mL) and clinical failure with glycopeptide monotherapy, we changed the antibiotic therapy to a fosfomycin and teicoplanin combination therapy. The patient showed improved clinical response in terms of her enhanced consciousness as well as subsidence of persisted bacteremia. Despite the potential side effects of fosfomycin (such as diarrhea and hypernatremia), it combined with a glycopeptide may be an alternative therapy for invasive refractory MRSA infections.

Original languageEnglish
JournalJournal of Microbiology, Immunology and Infection
Volume49
Issue number4
DOIs
Publication statusPublished - Aug 1 2016

Keywords

  • Fosfomycin
  • Glycopeptide
  • Methicillin-resistant Staphylococcus aureus
  • Osteomyelitis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases
  • Immunology and Allergy
  • Immunology and Microbiology(all)

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