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A case of ventricular drainage infection with a rare pathogen in cerebrospinal fluid: vancomycin-resistant

Mehmet Baysallar1, Yusuf Izci, Abdullah Kilic

  • 1Department of Microbiology and Clinical Microbiology, Gulhane Military Medical Academy, General Tevfik Saglam, 06018 Etlik, Ankara, Turkey. mbaysallar@gata.edu.tr

Microbial Drug Resistance (Larchmont, N.Y.)
|April 6, 2006
PubMed

Insights

A 7-month-old infant with ventriculoperitoneal shunts for hydrocephalus successfully recovered from ventriculitis caused by vancomycin-resistant Enterococcus faecium. Treatment involved a specialized antibiotic-impregnated shunt and targeted antibiotics based on susceptibility testing.

Area of Science:

  • Pediatric Infectious Diseases
  • Neurosurgery
  • Microbiology

Background:

  • Hydrocephalus management often requires ventriculoperitoneal shunts.
  • Ventriculitis, an infection of cerebrospinal fluid, poses a significant risk in shunt patients.
  • Emergence of multidrug-resistant organisms like vancomycin-resistant Enterococcus faecium complicates treatment.

Observation:

  • A 7-month-old infant with existing ventriculoperitoneal shunts developed fever and signs of ventriculitis.
  • Cerebrospinal fluid analysis revealed infection with vancomycin-resistant Enterococcus faecium.
  • Initial antibiotic therapy proved ineffective against the resistant bacterial strain.

Findings:

  • The infecting E. faecium strain exhibited resistance to multiple antibiotics, including vancomycin.
  • Susceptibility testing identified chloramphenicol, ciprofloxacin, streptomycin, levofloxacin, and rifampin as effective agents.
  • A rifampin-clindamycin-impregnated shunt was surgically implanted.
  • Combination therapy with chloramphenicol, rifampin, and meropenem was initiated.
  • The patient's condition improved, with sterile cerebrospinal fluid cultures achieved within 15 days.

Implications:

  • Rifampin-clindamycin-impregnated shunts may be crucial for managing ventriculitis caused by vancomycin-resistant Enterococcus faecium.
  • Antimicrobial susceptibility testing is vital for guiding effective antibiotic selection.
  • This approach offers a viable treatment strategy in regions lacking newer antibiotics like linezolid and quinupristin-dalfopristin.

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