Daptomycin efficacy in the central nervous system of a patient with disseminated methicillin-resistant Staphylococcus aureus infection: a case report

Fabrizio Taglietti,Giulia Stazi,Taschia Bertuccio,Antonino Di Caro,Elisabetta Grilli,Stefania Stefani,Nicola Petrosillo,Alessandro Capone,Floriana Campanile

doi:10.1186/1752-1947-6-264

Abstract

IntroductionStaphylococcus aureus has emerged as a major nosocomial pathogen in the last decades and also represents the second most common pathogen isolated from patients in outpatient settings. Although methicillin-resistant S.aureus infections were traditionally limited to hospitals, community-associated cases of methicillin-resistant S.aureus infections have been reported. In our case, we observed an unexpected event during treatment.Case presentationA 60-year-old Caucasian man developed fever and multiple muscle and brain abscesses caused by Panton-Valentine leukocidin-negative community-associated methicillin-resistant S. aureus.ConclusionAlthough our patient was given antimicrobials active against the isolated methicillin-resistant S. aureus strain, it was only after the introduction of daptomycin that his skin, soft tissue and muscle lesions and also brain manifestations improved.

Highlights

Staphylococcus aureus has emerged as a major nosocomial pathogen in the last decades and represents the second most common pathogen isolated from patients in outpatient settings
The overall burden of staphylococcal diseases caused by antibiotic-resistant Staphylococcus aureus (SA), by methicillin-resistant S. aureus strains (MRSA), is increasing in several countries, including Italy, where MRSA accounts for 25% to 50% of all hospitalisolated SA strains and causes 52.8% of intensive care unit (ICU)-acquired infections [2]
MRSA infections were traditionally limited to hospitals, community-associated cases of MRSA (CA-MRSA) infections have been reported since the late 1990s in the USA [3]

Summary

Introduction

Staphylococcus aureus (SA) has emerged as a major nosocomial pathogen in the last decades and represents the second most common pathogen isolated from patients in outpatient settings [1]. The vast majority of CA-MRSA carry one of two smaller staphylococcal cassette chromosome mec(SCCmec) types, IV and V, without the additional resistance genes, and are in general more susceptible to non-beta-lactam antibiotics They appear to be associated with increased transmission and hospitalization, skin and soft tissue infection and, rarely, severe diseases including necrotizing pneumonia [5]. Case presentation A 60-year-old Caucasian male retired nurse was admitted three years ago to our Infectious Diseases Hospital because of a three-day history of ingravescent dyspnoea, a skin abscess on his left arm and a very high fever. On day 4, his clinical conditions worsened and our patient presented with seizures: total-body computerized tomography showed multiple cerebral lesions described as brain abscesses, right pneumonia and scapular soft tissue abscesses (Figure 1). Daptomycin has been shown to be effective in central nervous system infection in humans and animal models [10,11]

Conclusions

Findings

Discussion

Lowy FD