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Case Commentary: Imipenem/Cilastatin and Fosfomycin for Refractory Methicillin-Resistant Staphylococcus aureus

George Sakoulas1

  • 1Division of Host-Microbe Systems & Therapeutics, Center for Immunity, Infection & Inflammation, Collaborative to Halt Antimicrobial Resistant Microbes, University of California-San Diego School of Medicine, La Jolla, California, USA george.sakoulas@sharp.com.

Antimicrobial Agents and Chemotherapy
|October 6, 2020
PubMed

Insights

Treating difficult methicillin-resistant Staphylococcus aureus bacteremia requires collaboration. A successful strategy involved using imipenem/cilastatin plus fosfomycin for a challenging MRSA infection.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Clinical Microbiology

Background:

  • Randomized clinical trials are unlikely to provide solutions for complex methicillin-resistant Staphylococcus aureus (MRSA) bacteremic infections.
  • Effective treatment of recalcitrant MRSA infections necessitates innovative therapeutic approaches.

Purpose of the Study:

  • To highlight the need for interdisciplinary collaboration in developing individualized antimicrobial therapies for challenging MRSA infections.
  • To present a case study demonstrating a successful novel treatment strategy for MRSA bacteremia and spinal abscess.

Main Methods:

  • Literature review on challenges in treating MRSA bacteremia.
  • Case report detailing the clinical course and treatment of a patient with MRSA bacteremia and spinal abscess.
  • Antimicrobial susceptibility testing and pharmacokinetic/pharmacodynamic considerations for combination therapy.

Main Results:

  • Identification of a treatment regimen combining imipenem/cilastatin with fosfomycin.
  • Successful resolution of a particularly recalcitrant MRSA bacteremia and associated spinal abscess.
  • Demonstration of a viable individualized therapeutic strategy for complex MRSA infections.

Conclusions:

  • Interprofessional collaboration between clinicians, microbiologists, and pharmacists is crucial for managing difficult MRSA infections.
  • Combination therapy with imipenem/cilastatin and fosfomycin can be effective against recalcitrant MRSA bacteremia.
  • Individualized antimicrobial selection is a key strategy for treating challenging Gram-positive bacterial infections.
Keywords:
MRSAantimicrobial combinationsbacteremia

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