Shock and Persistent MRSA Bacteremia

DeSena et al present a case of an 8-month-old African American baby girl presented with a 2-day history of lethargy, fever, diarrhea, and dehydration. She had metabolic acidosis with a bicarbonate level of 14 mEq/L (normal, 20-28). Urine cultures were obtained, and the patient was admitted for correction of dehydration and electrolyte abnormalities. The subsequent findings of coagulopathy, thrombocytopenia, acute renal failure, and mildly elevated bilirubin levels confirmed a clinical diagnosis of toxic shock syndrome. Both the blood and cerebrospinal fluid cultures from the second hospital day were positive for MRSA. They conclude that MRSA bacteremia persisting for more than 3 to 5 days after appropriate anti- biotics are started warrants examination of the heart with an echocardiogram. This should be considered after just 2 to 3 days of positive cultures in children with coronary heart disease or with a Central Venous Line (CVL).