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Short course of linezolid treatment for vancomycin-resistant Enterococcus faecium meningitis

T-N Tsai1, C-P Wu, M-Y Peng

  • 1Department of Internal Medicine, Division of Pulmonary and Critical Care, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.

International Journal of Clinical Practice
|June 30, 2006
PubMed

Insights

Meningitis is rarely caused by vancomycin-resistant enterococci. This report details the first case in Taiwan of meningitis caused by vancomycin-resistant Enterococcus faecium, successfully treated with linezolid.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Clinical Medicine

Background:

  • Enterococci are potential meningitis pathogens, though vancomycin-resistant strains are rare causes.
  • Meningitis is a serious central nervous system infection, often associated with significant morbidity and mortality.

Observation:

  • A 69-year-old man with chronic obstructive pulmonary disease and on long-term steroid therapy developed meningitis post-hospitalization for a urinary tract infection.
  • Cerebrospinal fluid culture revealed vancomycin-resistant Enterococcus faecium (VREfm).
  • Rectal swab also yielded identical VREfm, positive for the vanA gene.

Findings:

  • The patient's meningitis was caused by a vancomycin-resistant Enterococcus faecium strain harboring the vanA gene.
  • Pulsed field gel electrophoresis confirmed the isolates from cerebrospinal fluid and rectal swab were identical.
  • Successful treatment was achieved with intravenous linezolid (600 mg every 12 hours for 2 weeks).

Implications:

  • This case represents the first documented instance of meningitis due to vancomycin-resistant Enterococcus faecium in Taiwan.
  • Highlights the potential for VREfm to cause invasive infections, including meningitis, in immunocompromised patients.
  • Demonstrates the efficacy of linezolid in treating VREfm meningitis.

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