Infection due to methicillin-resistant Staphylococcus aureus
Martin C. McHenry, M.D.
Department of Internal Medicine, Section of Infectious Disease
Thomas L. Gavan, M.D.
Department of Clinical Pathology
Richard G. Farmer, M.D.
Department of Gastroenterology
Charles M. Evarts, M.D.
Department of Orthopedic Surgery
METHICILLIN-resistant strains of coagulase-positive Staphylococcus aureus were first isolated in Great Britain in 1960.1 The incidence of such strains has been low, but appears to be increasing in England, in Europe, and in the Scandinavian countries.2–5 In the United States, there have been few well-documented cases of serious infection due to methicillin-resistant, coagulase-positive staphylococci.6–9 We recently treated a patient with an infection due to an unusual strain of Staphylococcus aureus that was highly resistant to methicillin; findings in the case are the basis of this report.
Report of a case
A 21-year-old Caucasian housewife was admitted to the Cleveland Clinic Hospital on February 22, 1968, for treatment of a large gluteal abscess. The patient had been residing in India and was in apparent good health until the last week of November 1967. At that time, low-grade fever, malaise, and icterus developed. On November 29, 1967, she was admitted to a hospital in New Delhi, India, for treatment of infectious hepatitis. Between December 3 and December 8, 1967, the patient was comatose and required a cutdown in the right saphenous vein for intravenous fluid therapy. On December 12, fever and evidence of septic thrombophlebitis of the right saphenous vein developed. Between December 12 and December 27, the patient received a number of antibiotics including penicillin G, a tetracycline, erythromycin, oxacillin, and chloramphenicol, without noticeable improvement. During that interval, metastatic abscesses developed in the right sternoclavicular joint, in the upper lobe of the right lung, and in subcutaneous tissues of the abdomen, . . .