Introduction
The management of end stage heart failure remains limited by donor availability and recipient candidacy, which has resulted in increasing use of mechanical circulatory support (MCS) as bridge to transplantation or permanent destination therapy. Left ventricular assist devices (LVADs) offload a failing left ventricle, enhancing patient survival and quality of life. As newer generations of LVADs continue to reduce thrombosis risk our MCS patient population will continue to expand. However, infection remains a significant complication, increasing a patient’s morbidity and mortality. A patient’s driveline is the percutaneous tube connecting the internal VAD pump and the extracorporeal controlled unit. The driveline renders a patient highly susceptible to microbial contamination and represents a common source of infection. For this reason, Gram-positive skin flora are commonly implicated in LVAD-associated infections, including Staphylococcus aureus 1. The management of this patient population is guided by observational data and expert opinion and may be further complicated by pathogen type, infection location, and patient surgical/transplant candidacy status. While there is emerging data on synergistic antibiotic combinations for the management of methicillin resistant Staphylococcus aureus, there remains a significant gap in the literature for persistent methicillin sensitiveStaphylococcus aureus ( MSSA) 2. There are a handful of both in-vitro and in-vivo studies that suggest a synergistic effect of cefazolin and ertapenem combination therapy for persistent MSSA 3–5. Here we describe the successful use of oxacillin and ertapenem combination therapy in the treatment of LVAD-associated persistent MSSA bacteremia.