Abstract
We report two cases of methicillin-resistant Staphylococcus aureus (MRSA) respiratory infection in which Gram's stain procedure helped the medical staff in an ICU to identify the possible infection early. Two men, 67 (case 1) and 65 (case 2) years old, were admitted to our ICU for treatment of hypoxia caused by interstitial pneumonia. The patients showed bacterial respiratory infection during respiratory therapy, and cephalosporins were administered over a long period of time against gram-negative rods.
During the treatment with antibiotics, many gram-positive cocci and white blood cells with phagocytosis were identified by Gram's stain of the sputum, so ampicillin (case 1) or fosfomycin (case 2) was administered. However, after 24-48 hours, no changes were observed in the Gram's stain of the sputum. We suspected the existence of MRSA infection. In case 2, we started oral administration of vancomycin before identification by culture in the laboratory. When the MRSA respiratory infection was confirmed by the culture results from the laboratory, the Gram' s stain of the sputum was already negative.
This suggests that Gram's stain procedure may be useful for medical staff, especially in ICUs, to identify MRSA infections early and decide on the administration of the most effective antibiotics.
