Abstract
A 50-year-old man with MRSA septicemia due to infective endocarditis was treated using therapy combining vancomycin (VCM) with rifampicin (RFP) and sulfamethoxazole/trimethoprim (ST). He was admitted to our hospital with a diagnosis of acute pneumococcal meningitis in February 2000. In mid March, he had a high grade fever and MRSA was isolated from the blood. The isolated MRSA was susceptible to VCM and arbekacin (ABK). Intravenous VCM administration was started. MRSA bacteremia continued even after 3 weeks of VCM therapy. Subsequent combination therapy with intravenous ABK and sulbactam/ampicillin also failed to eradicate the organism from the blood. In mid April, transthoracic echocardiography revealed vegetation, suggesting infective endocarditis. Antibacterial therapy was immediately changed to intravenous VCM with both oral RFP and ST. After 10 days of aggressive antibiotic treatment, the blood culture was negative, and after 3 months, the outcome was a successful. This case emphasizes the efficacy of therapy combining RFP and ST in addition to VCM in a case of severe MRSA infection, especially involving infective endocarditis.
