An 11-year-old male student with no personal or family history of chronic diseases, hospitalizations, or recent use of antibacterial agents.
Ceftriaxone was started due to asthenia, adynamia of three weeks of evolution after a left dorsolumbar trauma associated with three days of fever up to 39°C.
The next day he was switched to cloxacillin (170 mg/kg/day) every 6 h.
CT angiography showed a left renal abscess of 5 cm in diameter.
On the fourth day of treatment, due to persistent fever and increased CRP to 270 mg/L, the regimen was changed to vancomycin (40 mg/kg/day) and meropenem (60 mg/kg/day).
After six days of vancomycin and with an unfavorable clinical evolution, increased inflammatory parameters and size of renal injury were taken from the collection to another institution for installation of a ureteral catheter (pig-tail) and drainage.
On the 5th postoperative day, fever decreased, with a decrease in inflammatory parameters.
The culture result was positive for MRSA.
With the microbiological report meropenem was suspended and vancomycin was maintained with good clinical response and definitely aphthous ulcer after 12 days of surgical drainage, normalization of CRP, renal function always preserved and ultrasound image with abscess regression
A total of 36 days of treatment with vancomycin was completed.
The strain was confirmed as MRSA, PV-L positive.
Molecular characterization corresponded to subtype CL-SAU-COM-SMA-002 (PFGE) and ST731 belonging to CC 30 by MLST.
A nasal carriage study was conducted on both parents, siblings and grandparents, all negative.
