The Importance of Early Source Control in Persistent MRSA Bacteremia: A Case Report

Persistent bacteremia, despite the susceptibility of the causative organism to appropriate antimicrobial therapy, presents a major clinical challenge. In such cases, early identification and control of the infectious source are essential to prevent complications and reduce mortality.

We report the case of a 59-year-old woman with persistent Methicillin-resistant Staphylococcus Aureus (MRSA) bacteremia following spinal surgery. Despite multiple days of intravenous antibiotic therapy, her blood cultures remained positive for MRSA. A tagged white blood cell (Technetium-99) scan revealed an abscess in the right sacroiliac joint. Surgical drainage of the abscess led to clinical improvement and resolution of bacteremia. Interestingly, cultures of the abscess fluid grew Enterococcus faecalis rather than MRSA.

This case underscores the importance of early source control in the management of persistent bacteremia. Even when the pathogen isolated from the presumed source differs from that in the bloodstream, drainage can play a critical role in resolving systemic infection.

Early source control should be pursued in persistent bacteremia, regardless of initial culture results. Imaging studies may assist in locating occult sources, and successful drainage may contribute to clinical improvement even when the primary bloodstream pathogen is not isolated from the source.