A Rare Case of Sacral Decubitus Injury Causing Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia With a Spinal Abscess

Sacral ulcers can be precipitated by poor circulation, damaged skin and tissue from immobility or direct trauma, poor nutrition, diabetes, and incontinence. If not treated promptly, the sacral ulcer can serve as a portal of entry for bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), into the bloodstream, leading to complications including bacteremia, abscesses, sepsis, and possible infectious endocarditis, as occurred in this case. During the patient's hospital stay, he was diagnosed with possible schizoaffective disorder with full mental capacity, but had multiple episodes of paranoia that made treatment planning even more difficult due to both his persistent refusal to diagnostic tests and physical therapy. The refusal of necessary diagnostic testing, particularly to rule out infectious endocarditis, limited treatment planning and could have provided important insight into his persistent bacteremia despite susceptible antibiotic therapy. Along with the sacral decubitus ulcer, the patient's case was complicated by paraspinal, psoas, epidural, and multiloculated gluteal abscesses with fungal infections around the groin. Overall, this case highlights the importance of correct antibiotic therapy, prevention, aggressive wound care, nutrition, and adherence to therapy recommendations, even if the patient has psychiatric issues, to mitigate severe complications associated with MRSA secondary to a sacral decubitus ulcer.