Dalbavancin was effective and safe after one year of treatment in a complicated osteoarticular infection caused by methicillin-resistant Staphylococcus aureus

Under treatment with lacosamide, phenobarbital, prokinetics, laxatives for constitutional constipation and protein supplements.From July 2018 to March 2019 the patient developed up to four episodes of fever, lumbar pain, right coxalgia, wound on the external and upper thigh and a palpable collection (figure 1).In all of them, blood tests revealed leukocytosis with left shift, as well as elevated CRP levels.The CT scan showed Harrington bar migration, coxofemoral joint invasion and contiguous collection (figure 2).In the culture of the collection, MRSA was isolated in all episodes in association with Proteus mirabilis with different antibiogram phenotypes (figure 1, table 1).On up to three occasions the case was brought to the attention of the Spine Unit of the Traumatology and Orthopaedic Surgery Department, which rejected the removal of osteosynthesis material due to the high surgical risk involved.Suppressive treatment was started for 6 weeks, keeping the patient afebrile and with a progressive decrease in biomarkers (CRP).The suppressive treatment regimens were initially combinations of linezolid 600 mg every 12 hours associated with ceftriaxone 2g every 24 hours iv, In the first cycle of treatment the patient developed thrombopenia and cholestasis.Subsequent treatment regimens were performed with daptomycin 10 mg/kg/day and ertapenem 1 g/24h.After the third episode of clinical recurrence, the case was discussed again with the Spine Unit who accepted the surgical revision.The Harrington Bar that caused the invasion of the coxofemoral joint was removed.The contralateral one and the Luque wires, which were included in the spinal arthrodesis, were maintained.Two months after removal, the patient returned to the emergency department with fever 38.5ºC, a spontaneous fistula with abundant purulent content, leukocytosis with left deviation and a CRP of 18.6 mg/dl.In the culture of the purulent material, MRSA with the same phenotype was reisolated.Suppressive treatment with dalbavancin 1500 mg every 15 days was started, with early clinical improvement, and the patient remained afebrile, and CRP decreased.During the months of Dalbavancin was effective and safe after one year of treatment in a complicated osteoarticular infection caused by methicillin-resistant Staphylococcus aureus