Adult Empyema Caused by Refractory Methicillin-Resistant Staphylococcus aureus Treated Using Linezolid as Salvage...

The pathogenesis and treatment of pulmonary lesions caused by methicillin-resistant Staphylococcus aureus (MRSA) infection have been unclear because MRSA has usually been considered a colonizer.

Two adult cases of MRSA empyema were treated using linezolid (LZD) because they were refractory to the glycopeptides vancomycin (VCM) and teicoplanin (TEIC). Case 1 was a 50-year-old man with a history of lung cancer and pneumothorax who was admitted with pulmonary empyema with a severe dry cough. MRSA empyema was diagnosed because only MRSA was detected by video-assisted thoracoscopy (VATS) from his effusions. He was initially treated using VCM for 10 days, but his inflammatory markers and condition did not so improve; therefore, VCM was switched to LZD. His condition improved with LZD for 14 days. Case 2 was a 77-year-old man with pharyngeal cancer who was admitted with respiratory failure. He was diagnosed with MRSA empyema because only MRSA was detected from his pleural effusions on pleural drainage. He received a TEIC drip infusion for 10 days, but his respiratory status did not so improve; therefore, his treatment was switched to LZD. His condition improved with LZD for 14 days.

MRSA empyema was diagnosed in these two cases because only MRSA was detected from pleural effusions. Both patients finally improved following the switch from glycopeptide antibiotics to LZD. These findings suggest MRSA as the true cause of the infections and that LZD, rather than VCM and TEIC, might be effective in cases of MRSA empyema.