MRSA Bacteremia

Today's noon report pieced together a wonderful illness script for MRSA bacteremia: 
   Middle aged man with recent untreated septic thrombophlebitis related to an IV who presented with RUE skin/soft tissue infection, subacute monocular blindness, acute chest pain, and fevers found to have MRSA bacteremia with pulmonary septic emboli and chorioretinitis without evidence of endocarditis.

An example of focal infective chorioretinitis

An example of focal infective chorioretinitis

Other learning points from the article that we reviewed Clinical characteristics of septic pulmonary embolism in adults: a systematic review. Respir Med. 2014 Jan;108(1):1-8

- The diagnosis of septic pulmonary embolism is supported by characteristic findings on contrast enhanced CT: multiple bilateral peripheral nodules (often pleural based) with or without cavitary change.

-Empiric coverage against Staph Aureus is indicated for pulmonary septic emboli.  In catheter related infections, consider treatment against candida in patients who are immunocompromised or have a malignancy.