Oxacillin plus ertapenem rapidly clears persistent left ventricular
assist device-related methicillin-susceptible Staphylococcus aureus
bacteremia
Abstract
There is an increasing use of left ventricular assist devices (LVADs) as
bridge to transplantation or permanent destination therapy in the heart
failure patient population. Infection remains a common complication in
LVADs, with Gram-positive skin flora as predominant pathogens
implicated, including Staphylococcus aureus. While there is
emerging evidence for synergistic antibiotic combinations with
methicillin resistant Staphylococcus aureus, there remains a
significant gap in the literature for persistent methicillin susceptible
Staphylococcus aureus (MSSA) bacteremia. In this article, we
describe the first successful treatment of persistent LVAD-related
bacteremia with salvage oxacillin plus ertapenem. The salvage therapy
described here must be balanced by the risks for toxicity, impact on
resistance, microbiota disruption, drug shortages, and patient costs.
This combination warrants further evaluation in the clinical setting to
better establish its role in our expanding patient population.