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+A 20-year-old male with cystic fibrosis was transferred to Houston Methodist Hospital in January 2013 to be evaluated for lung and kidney transplant.
+Patients with cystic fibrosis are known to develop chronic lung infections that adapt over time to this unique anatomic niche (14, 15).
+His complicated medical history included pancreatic insufficiency, liver transplantation in 2004, steroid-induced diabetes, end-stage renal disease, and testicular cancer.
+He had a long history of respiratory infections with several multidrug-resistant bacteria, including MRSA.
+He was treated with ceftaroline at an outside hospital immediately prior to transfer to Houston Methodist Hospital.
+The patient was periodically hospitalized from January to July 2013 and was treated for recurrent respiratory and catheter-related infections caused by MRSA and multidrug-resistant Pseudomonas aeruginosa.
+His antibiotic exposure included long treatment courses with various agents, including meropenem, ceftazidime, doxycycline, vancomycin, linezolid, cefepime, ciprofloxacin, and inhaled and systemic colistin and tobramycin.
+Shortly after being readmitted to our hospital in June 2013, MRSA was grown from cultures of blood and respiratory specimens.
+These two isolates were resistant to clindamycin, linezolid, oxacillin, and trimethoprim-sulfamethoxazole and susceptible to minocycline, rifampin, and vancomycin.
+His blood isolate grew confluently around the ceftaroline Etest strip, yielding an MIC of >32 mg/liter.
+Five additional S. aureus respiratory tract isolates were available for further study.
+All MRSA isolates from this patient had a small-colony-variant (SCV) phenotype.