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Vancomycin-resistant Enterococcus faecium meningitis in adults: case series and review of the literature

Bettina M Knoll1, Matt Hellmann, Camille N Kotton

  • 1Department of Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. bknoll@partners.org

Scandinavian Journal of Infectious Diseases
|September 21, 2012
PubMed
Abstract

Insights

Vancomycin-resistant Enterococcus faecium meningitis is rare but deadly. Various drug combinations, including linezolid and daptomycin, show promise for bacterial cure, though an optimal regimen remains elusive.

Area of Science:

  • Infectious Diseases
  • Neuroscience
  • Pharmacology

Background:

  • Vancomycin-resistant Enterococcus faecium (VRE) meningitis is a rare but severe infection with high mortality.
  • Limited therapeutic options exist for treating VRE meningitis, and optimal treatment strategies are not well-established.

Observation:

  • A retrospective review identified 4 adult cases of VRE meningitis at Massachusetts General Hospital (1999-2011).
  • A literature search identified 18 additional published cases of VRE meningitis.

Findings:

  • Successful treatment of VRE meningitis was achieved with various antimicrobial agents, including linezolid, daptomycin, quinupristin-dalfopristin (QD), and chloramphenicol.
  • Treatment regimens included monotherapy and combination therapy, with intravenous (IV) and intrathecal (IT) administration considered.
  • One case with a vancomycin-resistant, linezolid-intermediate isolate was successfully treated with QD and daptomycin.

Implications:

  • Bacterial cure for VRE meningitis is achievable with diverse antimicrobial strategies.
  • The choice of therapy, including IV and IT routes, should consider drug properties.
  • The rarity of VRE meningitis precludes definitive identification of an optimal treatment regimen.

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