Future directions and conclusion
In conclusion, we present a case of the successful use of oxacillin and ertapenem for the management of persistent MSSA bacteremia in an LVAD patient. Staphylococcus aureus is notorious for the common metastatic spread of infection, which has been correlated with the duration of bacteremia. Prompt clearance of blood cultures was noted within 24 hours from combination initiation, similarly to available published data. Based on in vitro data, cefazolin had been utilized previously for salvage therapy. This is the first case report in the MCS setting describing successful use of oxacillin with ertapenem. The salvage therapy described here must be balanced by the risks for toxicity, impact on resistance, microbiota disruption, drug shortages, and patient costs. Questions regarding optimal timing of initiation of ertapenem, duration of combination therapy, repeated efficacy of combination therapy, and extrapolation to other MCS patients in which source control may be challenging. It is also critical to recognize that no patient-centered benefit has been established and combination therapy risks have not been fully explored. Ultimately, this combination warrants further evaluation in the clinical setting to better establish its role in patient care.