Abstract | November 18, 2023
Atypical Source of Cystitis-Causing MRSA Bacteremia
Learning Objectives
- Recognize an abnormal presentation and origin of MRSA bacteremia primarily sourced from cystitis: The case report aims to highlight the atypical presentation of MRSA bacteremia originating from cystitis, which is not commonly associated with MRSA bloodstream infections. By presenting this case, the objective is to increase awareness among clinicians about the possibility of cystitis as a source of MRSA bacteremia.
- Understand the importance of thorough investigation to identify the source of infection: The case report emphasizes the significance of conducting a comprehensive workup to identify the source of MRSA bacteremia when conventional sources are not apparent. It demonstrates the need for thorough investigations, such as imaging studies and repeated cultures, to determine the underlying cause and guide appropriate treatment.
- Improve clinical suspicion of cystitis as an origin of MRSA bacteremia: By presenting this case, the report aims to raise awareness among healthcare professionals about the potential association between MRSA cystitis and bloodstream infection. It encourages clinicians to consider cystitis as a possible source of MRSA bacteremia, even in the absence of typical risk factors or clinical findings.
- Enhance understanding of the management approach for MRSA bacteremia: The case report highlights the management strategies employed in this specific case, including the use of IV vancomycin and the placement of a foley catheter to relieve bladder distention. It provides insights into the therapeutic interventions that were successful in resolving the MRSA bacteremia in this patient.
The purpose of this case report is to highlight an abnormal presentation and origin of MRSA bacteremia primarily sourced from cystitis. A 64-year-old male with a PMH significant for uncontrolled IDDM2(HgA1C >12), CAD and hypertension presented to the ED with altered mentation. His initial presentation was secondary to diabetic ketoacidosis and severe sepsis due to a urinary tract infection, requiring admission to the ICU for insulin and antibiotic therapy. Patient had also been experiencing urinary retention for the month prior and required a urinary catheter for a short period, symptoms secondary to effects of uncontrolled diabetes causing neurogenic bladder. His initial blood cultures showed MRSA bacteremia. Patient was started on IV vancomycin and workup to investigate source of MRSA bacteremia began.
Primary differential included MRSA bacteremia secondary to endocarditis vs paraspinal abscess vs dental abscess. TTE revealed a calcific echodensity with an uncertain etiology of degenerative tissue vs possible vegetation. A TEE followed these results which denied the appearance of a vegetation and concluded the density more consistent with degenerative tissue. Investigations continued yet patient declined any associations with typical sources of MRSA infiltration. Full physical examination completed with no significant findings. Multiple subsequent blood cultures continued to grow MRSA in 2/2 bottles, with additional urine culture growing MRSA. Cardiology and Infectious Disease were consulted regarding the multiple positive blood cultures with no successful therapy or source. MRI thoracic and lumbar spine negative for osteomyelitis yet revealed severe bladder distention with bilateral hydronephrosis. Bladder scan revealed 2L urine present and ultimately a foley catheter was placed. Blood cultures obtained after catheter placement and those checked on the following days ultimately resulted negative given the release of MRSA contaminated urine.
This led to the suspicion of MRSA bacteremia being primarily sourced from MRSA cystitis given the subsequent negative blood culture result. Through this case presentation, the importance of full investigation to discover the source of infection was proven necessary to treat the bacteremia and highlighting this case will allow for clinicians to suspect cystitis as an atypical origin of MRSA bacteremia.
References and Resources
