TABLE 7.

Clinical cases of successfully treated hVISA or VISA infectionsc

Predominant antibiotic therapyaNo. of casesFeature of caseKey feature(s) of treatmentOutcome and descriptionReference(s)
Linezolid1MRSA endocarditis. Failed VAN (90 days) despite trough levels up to 43 μg per mlOral LZD, no surgeryCured7
1MRSA endocarditis and septic thrombophlebitis; failed VAN and then DPT (58 days of bacteremia)Changed to LZD + FACleared bacteremia; died from candidemia131
1MRSA endocarditis; failed VAN and then DPT (10 wk); developed VISA and reduced DPT susceptibilityChanged to LZD + SXT; also had course of QDCured; thrombocytopenia from LZD, severe arthralgias/myalgias from QD348
94 endocarditis, 3 OM, 1 bacteremia + OM, 1 empyema; VAN MIC of 2 μg per ml (n = 6) + 4 μg per ml (n = 3)Surgery (n = 5); linezolid aloneEffective (n = 7), not effective (n = 2)124
1MRSA AV and MV endocarditis with implantable defibrillator; SA-RVS; failed VANLZD for 67 days; removal of implantable defibrillatorInfection cleared but developed recurrent MRSA bacteremia 2 mo later384
Linezolid and then rifampin + fusidic acidb83 endocarditis, 2 bacteremia + SA/OM, 2 bacteremia + intra-abdominal infection, 1 prosthetic joint; VAN MIC of 2 μg per ml (n = 5) + 4 μg per ml (n = 3)Surgery (n = 5)Effective (n = 6), not effective (n = 2)124
Linezolid + other agents1VISA hepatic abscess (VAN MIC of 8 μg per ml), after 10 wk VANSurgery, LZD + SXT + DOXInfection cleared90, 107
1MRSA prosthetic AV valve endocarditis after repeated bacteremia and VAN therapy; failed VAN (MIC of 6 μg per ml by Etest)LZD + AMI, no surgeryCured176
1MRSA-infected hip fracture after fixation; failed debridement and VAN therapy (last isolate Etest MIC of 4 μg per ml)LZD + RIF, further debridementInfection cleared376
Rifampin +32 bacteremia, 1 OM; VAN MIC of 2Surgery (n = 2), oralCured (n = 1)124
    fusidic acid    μg per ml (n = 2) + 4 μg per ml    RIF + FANot effective (n = 1)
    (n = 1)NA (n = 1)
Others1VISA (MIC of 8 μg per ml), bacteremia and vertebral OM; prior 18 wk of VANVAN + NAF + GENInfection cleared; died from another cause90
1Recurrent MRSA bacteremia; VISA (MIC of 8 μg per ml) after 18 wk of VANGEN + RIFInfection cleared; died from candidemia326
1Recurrent peritonitis in peritoneal dialysis pt VISA (MIC of 8 μg per ml) after 18 wk of VAN; failed VAN treatmentSXT + RIFInfection cleared326
  • a Defined as the main antistaphylococcal antibiotic therapy used to cure the infection or to obtain control of the infection prior to long-term suppression.

  • b One patient received linezolid followed by fusidic acid plus chloramphenicol. One patient received rifampin plus fusidic acid followed by linezolid.

  • c VAN, vancomycin; DPT, daptomycin; SXT, trimethoprim-sulfamethoxazole; RIF, rifampin; FA, fusidic acid; QD, quinupristin-dalfopristin; DOX, doxycycline; NAF, nafcillin; NA, not applicable; SA, septic arthritis; OM, osteomyelitis; AV, aortic valve; MV, mitral valve; AMI, amikacin; LZD, linezolid; GEN, gentamicin.