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Background <p>Despite progress in new antibiotic development, active surveillance, and infection prevention, health care-associated methicillin-resistant <i>Staphylococcus aureus</i> (HA-MRSA) remains a major pathogen; it continues to pose a high-risk threat, especially in extremely elderly patients with necrotizing pneumonia and multiorgan dysfunction on polypharmacy. Multimorbidity, immunosenescence, and frailty in the elderly increase the risk of adverse outcomes, severely restricting therapeutic options.</p> Case presentation <p>We present the case of a long-term hospitalized 95-year-old woman with multimorbidity and multiorgan dysfunction who developed hospital-acquired necrotizing pneumonia due to MRSA. The diagnosis was established through metagenomic next-generation sequencing, bacterial culture of bronchoalveolar lavage fluid (BALF), and imaging. Linezolid was initially incorporated into the antimicrobial treatment regimen. After three weeks, owing to the bone marrow suppression caused by linezolid, contezolid (400&#xa0;mg PO every 12&#xa0;h) was adopted as an alternative therapy; this led to a significant reduction in the size of the lung cavity. Considering the cost-effectiveness and persistent risk of <i>Pseudomonas aeruginosa</i> and <i>Elisabethia pacificus</i> infection, as evidenced by the BALF culture results obtained at that time, the treatment was subsequently adjusted to oral linezolid combined with intravenous levofloxacin to achieve better infection control.</p> Conclusions <p>This case demonstrates the effectiveness of a sequential approach with a linezolid‒contezolid strategy for treating HA-MRSA-induced necrotizing pneumonia, leading to the regression of cavitary lesions and significant clinical improvement in elderly patients with multimorbidity, highlighting the importance of individualized treatment strategies in managing complex infections in vulnerable patient populations and offering valuable insights for future clinical practice.</p> Clinical trial number <p>Not applicable.</p>

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Effective sequential therapy of linezolid and contezolid against HA-MRSA-induced necrotizing pneumonia in a 95-year-old patient with multimorbidity

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月24日

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  • Ran Wang,
  • Shuping Shen,
  • Tianping Zheng,
  • Yuxing Zhang,
  • Wei Xu,
  • Jianqing Wu

摘要

Background

Despite progress in new antibiotic development, active surveillance, and infection prevention, health care-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) remains a major pathogen; it continues to pose a high-risk threat, especially in extremely elderly patients with necrotizing pneumonia and multiorgan dysfunction on polypharmacy. Multimorbidity, immunosenescence, and frailty in the elderly increase the risk of adverse outcomes, severely restricting therapeutic options.

Case presentation

We present the case of a long-term hospitalized 95-year-old woman with multimorbidity and multiorgan dysfunction who developed hospital-acquired necrotizing pneumonia due to MRSA. The diagnosis was established through metagenomic next-generation sequencing, bacterial culture of bronchoalveolar lavage fluid (BALF), and imaging. Linezolid was initially incorporated into the antimicrobial treatment regimen. After three weeks, owing to the bone marrow suppression caused by linezolid, contezolid (400 mg PO every 12 h) was adopted as an alternative therapy; this led to a significant reduction in the size of the lung cavity. Considering the cost-effectiveness and persistent risk of Pseudomonas aeruginosa and Elisabethia pacificus infection, as evidenced by the BALF culture results obtained at that time, the treatment was subsequently adjusted to oral linezolid combined with intravenous levofloxacin to achieve better infection control.

Conclusions

This case demonstrates the effectiveness of a sequential approach with a linezolid‒contezolid strategy for treating HA-MRSA-induced necrotizing pneumonia, leading to the regression of cavitary lesions and significant clinical improvement in elderly patients with multimorbidity, highlighting the importance of individualized treatment strategies in managing complex infections in vulnerable patient populations and offering valuable insights for future clinical practice.

Clinical trial number

Not applicable.