Effective sequential therapy of linezolid and contezolid against HA-MRSA-induced necrotizing pneumonia in a 95-year-old patient with multimorbidity
Abstract
BACKGROUND: Despite progress in new antibiotic development, active surveillance, and infection prevention, health care-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) remains a major pathogen; it continues to pose a high-risk threat, especially in extremely elderly patients with necrotizing pneumonia and multiorgan dysfunction on polypharmacy. Multimorbidity, immunosenescence, and frailty in the elderly increase the risk of adverse outcomes, severely restricting therapeutic options. CASE PRESENTATION: We present the case of a long-term hospitalized 95-year-old woman with multimorbidity and multiorgan dysfunction who developed hospital-acquired necrotizing pneumonia due to MRSA. The diagnosis was established through metagenomic next-generation sequencing, bacterial culture of bronchoalveolar lavage fluid (BALF), and imaging. Linezolid was initially incorporated into the antimicrobial treatment regimen. After three weeks, owing to the bone marrow suppression caused by linezolid, contezolid (400 mg PO every 12 h) was adopted as an alternative therapy; this led to a significant reduction in the size of the lung cavity. Considering the cost-effectiveness and persistent risk of Pseudomonas aeruginosa and Elisabethia pacificus infection, as evidenced by the BALF culture results obtained at that time, the treatment was subsequently adjusted to oral linezolid combined with intravenous levofloxacin to achieve better infection control. CONCLUSIONS: This case…
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