Sequential Therapy of Linezolid and Contezolid to Treat Hematogenous Lung Abscess Caused by Staphylococcus aureus in a Congenital Cerebral Hypoplasia Patient: A Case Report

Abstract

Staphylococcus aureus is a common pathogen of hematogenous lung abscesses. The increased resistance of S. aureus to antibiotics makes infections difficult to treat, often resulting in a poor prognosis. Therefore, it is important to identify S. aureus infections as early as possible and evaluate its sensitivity and resistance to antibiotics, to formulate an appropriate treatment plan. Oxazolidinone antibiotics exhibit potent antibacterial activity against multidrug-resistant (MDR) S. aureus; however, the adverse effects of linezolid, particularly thrombocytopenia, limit its application. Contezolid may ameliorate the hematologic toxicity associated with linezolid. Here, we report the case of a patient with congenital cerebral hypoplasia who was hospitalized due to fever and multiple abscesses in both lungs. In the context of negative blood culture results, the final diagnosis of MDR S. aureus as the causative agent of hematogenous lung abscess was confirmed using macrogenomic next-generation sequencing (mNGS) and targeted next-generation sequencing (tNGS). The patient was treated with linezolid but developed significant thrombocytopenia, so switching to sequential therapy with contezolid, the patient's platelet counts returned to normal and his condition improved significantly.

Keywords: Staphylococcus aureus; congenital cerebral hypoplasia; contezolid; hematogenous lung abscess; linezolid; next-generation sequencing.

Figure 1

(A) Chest CT on March 2, 2024, showed multiple nodules and patchy areas of increased density in both lungs, with gas density shadows observed inside the larger nodules, indicating the possibility of an Aspergillus infection, as well as pleural effusion on both sides. (B) Chest CT on March 12, 2024, showed that the multiple nodules and patchy areas of increased density in both lungs were similar in severity to those observed on March 2, 2024, with gas density shadows seen inside the larger nodules, although their size had reduced compared to the previous scan. (C) Chest CT on April 7, 2024, indicated that the multiple nodules and patchy areas of increased density in both lungs, with gas density shadows seen inside the larger nodules and pleural effusion on both sides, had significantly reduced in size compared to the findings on March 12, 2024. (D) Chest CT performed at another hospital on April 21, 2024, showed that the inflammatory lesions in the patient’s lungs had significantly absorbed and improved.

Figure 2

The patient’s dorsalis skin of the right foot was ulcerated.

Figure 3

Coverage of Staphylococcus aureus detected by mNGS in BALF sample.

Figure 4

Timeline of the patient’s diagnosis, treatment, and follow-up.