Methicillin resistant Staphylococcus aureus epidural spinal abscess [Neurosurgery Wiki]

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=====Methicillin resistant Staphylococcus aureus epidural spinal abscess=====
Available published studies demonstrate a clinically important burden of [[surgical site infection]]s (SSIs) related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations
((Patel H, Khoury H, Girgenti D, Welner S, Yu H. Burden of Surgical Site
Infections Associated with Select Spine Operations and Involvement of
Staphylococcus aureus. Surg Infect (Larchmt). 2017 May/Jun;18(4):461-473. doi:
10.1089/sur.2016.186. Epub 2016 Nov 30. PubMed PMID: 27901415; PubMed Central
PMCID: PMC5466015.
)).

[[Methicillin resistant Staphylococcus aureus]] (MRSA) [[spinal epidural abscess]] was successfully treated with combination therapy consisting of high-dose [[daptomycin]] (DAP, 10 mg/kg) and rifampicin. The patient's condition was complicated with multiple infectious foci, including an iliopsoas abscess and epidural abscess, as well as discitis and spondylitis at the cervical, thoracic and lumbar levels. Monotherapy treatments with [[vancomycin]], [[linezolid]] and usual-dose DAP were all ineffective. It has been shown that usual-dose DAP administration may result in the emergence of a resistant strain and treatment failure. We would like to emphasize the importance of high-dose DAP therapy for MRSA bacteremia, a condition with a potentially high mortality rate
((Hagiya H, Terasaka T, Kimura K, Satou A, Asano K, Waseda K, Hanayama Y, Otsuka
F. Successful treatment of persistent MRSA bacteremia using high-dose daptomycin 
combined with rifampicin. Intern Med. 2014;53(18):2159-63. Epub 2014 Sep 15.
PubMed PMID: 25224207.
)).
----
A MRSA epidural abscess in a 48-year-old woman was successfully treated with ceftaroline fosamil 600 mg every 12 hours as salvage therapy
((Bucheit J, Collins R, Joshi P. Methicillin-resistant Staphylococcus aureus
epidural abscess treated with ceftaroline fosamil salvage therapy. Am J Health
Syst Pharm. 2014 Jan 15;71(2):110-3. doi: 10.2146/ajhp130246. PubMed PMID:
24375602.
)).

====2011====
A 70-year-old Japanese man developed fever, headache, and lumbago, presumably due to an epidural abscess caused by methicillin-resistant Staphylococcus aureus (MRSA) in the L5-S2 region. On the night of admission to our hospital, he showed disorientation to places and abnormal eating behavior, indicating a complication of MRSA meningitis. Cerebrospinal fluid (CSF) examination confirmed this diagnosis. Although he was treated with venous infusion of vancomycin and meropenem, the CSF culture remained positive for MRSA even a week after the treatment, and Gram-positive cocci were also seen in the CSF. An intrathecal injection of vancomycin (10mg/day) was subsequently added, which resulted in absence of the organism on Gram-stained CSF smear and CSF culture a week later. His condition improved without any adverse effects. Vancomycin cannot freely penetrate the blood-brain barrier (BBB); therefore, when administered intravenously, its concentration in the CSF is insufficient. Therefore, intrathecal injection of vancomycin is necessary to achieve the desired bacteriocidal level in the CSF. Thus, intrathecal administration of vancomycin seems a very effective and safe treatment for MRSA meningitis
((Goto K, Ohi T, Namba A, Uemura N, Kitaguchi H. [Successful treatment of
methicillin-resistant staphylococcus aureus meningitis by intrathecal injection
of vancomycin]. Brain Nerve. 2011 Apr;63(4):417-21. Japanese. PubMed PMID:
21441646.
)).

====2010====
A 28-year-old man was admitted with severe thoracic pain, a body temperature of 37.20, paraplegia and sphincter disturbances. MRI revealed an epidural abscess T5T8. A decompressive laminectomy T5T8 was performed and the abscess was removed. A methicillin-resistent Staphylococcus aureus was cultured. Vancomycin was administered. Six months later muscle testing showed values from 3/5 to 4/5. MRI is the first choice diagnostic tool. Laminectomy, drainage and intravenous antibiotics constitute the basic treatment. Antibiotics alone can be sufficient in case of whole spine involvement, lumbosacral localization without neurological symptoms, fixed neurological deficit, complete paralysis for more than 72 hours, or severe concomitant medical problems
((Shaoqi H, Lixing L, Chengxuan T, Guojing Y. Epidural abscess T5T8 due to
methicillin-resistent staphylococcus aureus in an immunocompetent patient. Acta
Orthop Belg. 2010 Oct;76(5):706-8. PubMed PMID: 21138231.
)).