SHM Converge Scientific Abstract ePoster Gallery-A Case of Prolonged Staphlococcus Bacteremia With an Unusual Source

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This case describes a 78-year-old man with diabetes who was hospitalized for improving <em>Clostridium difficile</em> diarrhea and later developed fever and severe back pain on hospital day 7. Exam showed abdominal petechiae and nodules at enoxaparin injection sites, along with spinal tenderness.

Blood cultures grew methicillin-resistant <em>Staphylococcus aureus</em> (MRSA), and bacteremia persisted for 7 days despite appropriate IV vancomycin. Workup for common sources was negative, including transthoracic and transesophageal echocardiograms, which showed no endocarditis. An initial spinal MRI on day 8 did not show osteomyelitis. Additional imaging, including CT scans and a gallium scan, identified right anterior abdominal subcutaneous thickening with a 1.2 cm hyperdensity, later consistent with a dislodged insulin needle. A repeat MRI on day 17 then revealed T4–T7 osteomyelitis.

The presumed source of the prolonged bacteremia was an unusual one: subcutaneous injection with poor skin hygiene and a retained foreign body. This case highlights that persistent MRSA bacteremia requires aggressive search for a source and source control. It also demonstrates that early MRI may miss developing osteomyelitis, so repeat imaging may be necessary when suspicion remains high.

Overall, the report emphasizes the importance of careful history taking, detailed physical examination, and reconsideration of unusual infection sources when bacteremia does not clear as expected.

Asset Subtitle

Cindy Fang

Meta Tag

Author List Benjamin Verplanke, Cindy Fang

Category Clinical Vignettes

Concept Staphylococcus aureus Bacteremia

Concept Source Identification

Concept Source Control

Concept Methicillin-Resistant Staphylococcus aureus

Concept Persistent bacteremia

Distinguished Non-Finalist

Presenter Organization Nyu

Presenting Author Cindy Fang

Track Adult

Keywords

MRSA bacteremia

osteomyelitis

Clostridium difficile

vancomycin

persistent bacteremia

subcutaneous injection

retained foreign body

insulin needle

spinal pain

source control

Staphylococcus aureus Bacteremia

Source Identification

Source Control

Methicillin-Resistant Staphylococcus aureus

Persistent bacteremia