2012 Volume 15 Issue 4 Pages 554-557
A man in his 60s had a history of diabetes mellitus, alcoholic liver dysfunction, and hypertension. Three days after developing a fever, he became unable to move at home, and he was transferred to our hospital by ambulance. On arrival, his temperature was 39.2˚C, and he had lower back pain and findings of increased inflammation, hepatic and renal dysfunction on blood tests, increased white blood cells in the urine sediment, and enlarged bilateral renal parenchyma and dirty fat signs around the kidneys on abdominal CT. Treatment was started with broad spectrum antibiotics and γ-globulin. Anti-methicillin-resistant Staphylococcus aureus (MRSA) agents were started 6 hours after arrival because Gram-positive bacteria were detected in his urine on arrival at the hospital. MRSA was identified in urine and blood cultures on hospital Day 3. Acute respiratory distress syndrome (ARDS) developed on hospital Day 9. Mechanical ventilator management was required, and the antibiotic was changed, but the patient’s condition deteriorated; he developed multiple organ failure and died on Day 47. The MRSA isolate had staphylococcal cassette chromosome mec (SCCmec) type IV, and the patient was diagnosed as having sepsis from a urinary tract infection due to community-acquired MRSA (CA-MRSA). In recent years, infection of respiratory organs and soft tissue with CA-MRSA has become a global problem. As shown in the present case, CA-MRSA infection to the urinary tract may also have already spread.
