Existing recommended first-line antibiotic agents for MRSA pneumonia have several shortcomings. We reviewed 29 cases of community- and hospital-acquired MRSA pneumonia managed at our hospital. Lincosamide monotherapy was administered to 21/29 (72%) and was the predominant antibiotic regimen (> 50% course duration) in 19/29 (66%). Patients receiving lincosamide-predominant monotherapy were no more likely to die or require intensive care unit admission than patients receiving vancomycin-predominant monotherapy (5/19 (26%) versus 4/7 (57%), p = 0.19); 5/7 (71%) patients admitted to ICU and 4/5 (80%) bacteraemic patients received lincosamide-predominant monotherapy. MRSA pneumonia can be safely treated with lincosamide monotherapy if the isolate is susceptible.

BACKGROUND: Good toothbrush and towel handling are important considerations in personal hygiene. Thus, this study sought to assess how students of the University for Development Studies handle their toothbrushes and towels and the consequence of that with regards to the microbial quality of these personnel hygiene materials.
METHODS: A total of 100 swap samples were collected (50 toothbrushes and 50 towels) for microbial analysis. Questionnaires were administered to students from whom samples were collected to ascertain information on how they handle toothbrushes and towels. MacConkey agar and Mannitol Salt agar were used to isolate E. coli and S. aureus respectively, and cefoxitin used to identify the methicillin-resistant S. aureus strains.
RESULTS: E. coli was present in all sampled towels, while 98% of the sampled toothbrushes contained E. coli. It was found that 2% of the respondents kept their toothbrushes in bathhouses, 44% kept them unenclosed in rooms and 54% kept them enclosed in rooms (54%). Also, 48% of the respondents washed their towels once a week, 24% washed once every two weeks, 20% once every month and 8% once a trimester. Moreover, 52% dried their towels in rooms while 48% dried them outside rooms. The occurrence of S. aureus was 96% and 94% respectively for the towels and toothbrushes. Of the S. aureus isolated, 33.3% of sampled towels and 12.8% of the toothbrushes contained methicillin-resistant S. aureus.
CONCLUSIONS: This study found that, students are at risk of contracting infectious disease if their personal hygiene behaviours do not changed.

BACKGROUND: Infective endocarditis is more prevalent among children with congenital heart diseases as compared to healthy children. Community-acquired methicillin-resistant Staphylococcus aureus is a causative pathogen of infective endocarditis, and it rarely causes pancarditis in healthy children. The clinical decision for surgical intervention of left-sided heart vegetation is challenging despite the availability of management guidelines.
METHODS: We report a case of a previously healthy 12-year-old girl who presented with aggressive endocarditis secondary to community-acquired methicillin-resistant Staphylococcus aureus infection, with left-sided vegetation, mitral valve regurgitation, pancarditis, brain abscess, and stroke. She underwent an emergency vegetectomy and mitral valve repair. Three weeks after the first surgery, she developed left ventricular pseudoaneurysm that required life-saving surgical intervention. The child gradually recovered and was discharged home with acceptable cardiac function and mild neurological deficit.
CONCLUSIONS: Pancarditis, especially with an aggressive progression resulting in intracardiac pseudoaneurysm, is rarely reported in healthy children. The definition of the optimal timing of surgical intervention in pediatric infective endocarditis management is lacking and the clinical decision-making process remains challenging. The development of left ventricular pseudoaneurysm is serious and also needs an immediate intervention, given the high risk of its rupture and subsequent devastating outcomes.
CONCLUSIONS: Community-acquired methicillin-resistant Staphylococcus aureus is an etiology for aggressive infective pancarditis in a healthy child, leading to an intracardiac pseudoaneurysm. Emergency surgical interventions should be considered in children with left-sided vegetation to prevent devastating consequences.

UNASSIGNED: Evidence supporting beta-lactam plus vancomycin synergy for methicillin-resistant Staphylococcus aureus (MRSA) continues to grow. Current in vivo evidence demonstrates that combination therapy is associated with shorter time to blood sterilization than vancomycin monotherapy. However, this combination has not been reported as salvage therapy for persistent MRSA bacteremia.
UNASSIGNED: We report a case of an 81-year-old male who was successfully treated with vancomycin plus nafcillin after failing vancomycin monotherapy, daptomycin monotherapy, and daptomycin plus gentamicin combination therapy. The patient originally presented with sepsis from a suspected urinary tract infection. Blood cultures drawn on days 1, 3, 5, 15, 19, 23, and 28 remained positive for MRSA despite multiple antimicrobial therapy changes. On day 29, therapy was changed to vancomycin plus nafcillin. Blood cultures drawn on day 32 remained negative. After 11 days, nafcillin was changed to piperacillin-tazobactam due to an infected decubitus ulcer. The combination was continued for 42 days after achieving blood sterility, 71 days after the patient originally presented. Evidence regarding salvage therapy for persistent bacteremia is sparse and is limited to case reports and case series.
UNASSIGNED: This case report supports that vancomycin plus an anti-staphylococcal beta-lactam combination should be further studied as salvage therapy for persistent MRSA bacteremia.