Future directions and conclusion
In conclusion, we present a case of the successful use of oxacillin and
ertapenem for the management of persistent MSSA bacteremia in an LVAD
patient. Staphylococcus aureus is notorious for the common
metastatic spread of infection, which has been correlated with the
duration of bacteremia. Prompt clearance of blood cultures was noted
within 24 hours from combination initiation, similarly to available
published data. Based on in vitro data, cefazolin had been utilized
previously for salvage therapy. This is the first case report in the MCS
setting describing successful use of oxacillin with ertapenem. The
salvage therapy described here must be balanced by the risks for
toxicity, impact on resistance, microbiota disruption, drug shortages,
and patient costs. Questions regarding optimal timing of initiation of
ertapenem, duration of combination therapy, repeated efficacy of
combination therapy, and extrapolation to other MCS patients in which
source control may be challenging. It is also critical to recognize that
no patient-centered benefit has been established and combination therapy
risks have not been fully explored. Ultimately, this combination
warrants further evaluation in the clinical setting to better establish
its role in patient care.