# Successful resolution of methicillin-sensitive Staphylococcus aureus bacteraemia complicated by infective endocarditis in a patient with malignancy: a case report of effective combined intravenous nafcillin and ceftaroline therapy

## TL;DR

A cancer patient with a severe staph infection and heart complications was successfully treated with a combination of two antibiotics, avoiding surgery.

## Contribution

Demonstrates effective use of nafcillin and ceftaroline for MSSA infective endocarditis in a high-risk oncology patient.

## Key findings

- Combination therapy cleared persistent MSSA bacteraemia and resolved infective endocarditis within 72 hours.
- The patient completed 6 weeks of antibiotics with no recurrence of infection.
- Dual beta-lactam therapy may be a viable alternative when surgery is not an option.

## Abstract

Infective endocarditis (IE) is a life-threatening complication of bacteraemia, with a high mortality rate especially in immunocompromised individuals. Cancer patients receiving chemotherapy through implanted venous access devices are at an elevated risk of healthcare-associated bacteraemia. While surgery is often indicated for persistent bacteraemia or embolic complications, it may be contraindicated in patients with significant comorbidities. Combination beta-lactam therapy, particularly with nafcillin and ceftaroline, has shown promise in clearing persistent methicillin-sensitive Staphylococcus aureus (MSSA) bacteraemia but has not been widely reported in oncology populations.

We present a case of 49-year-old woman with stage IA triple-negative breast cancer on chemotherapy via Port-a-Cath who was admitted to hospital with sepsis. Blood cultures revealed MSSA and echocardiography confirmed mitral valve vegetation, consistent with IE. Despite cefazolin therapy and port removal, bacteraemia persisted for 7 days. MRI and CT imaging revealed multiple embolic events, including cerebral infarcts and pulmonary emboli. Due to her poor surgical candidacy, combination therapy with IV nafcillin and ceftaroline was initiated. Fevers resolved and blood cultures cleared within 72 h. Ceftaroline was discontinued after 7 days, and nafcillin continued for 17 days before transitioning to cefazolin. She successfully completed 6 weeks of antibiotics with no recurrence of bacteraemia or IE.

This case demonstrates successful eradication of persistent MSSA IE using combination nafcillin and ceftaroline in a high-risk cancer patient for whom surgery was declined. It supports the potential role of dual beta-lactam therapy in managing complex IE when surgical options are limited.