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Daptomycin plus trimethoprim/sulfamethoxazole combination therapy in post-neurosurgical meningitis caused by

Antonio Vena1, Marco Falcone, Emma Comandini

  • 1Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.

Diagnostic Microbiology and Infectious Disease
|March 5, 2013
PubMed

Insights

Post-neurosurgical meningitis caused by linezolid-resistant methicillin-resistant Staphylococcus epidermidis (MRSE) was successfully treated with daptomycin plus trimethoprim/sulfamethoxazole (TMP/SMX). This combination offers a promising therapeutic option for challenging central nervous system infections.

Area of Science:

  • Infectious Diseases
  • Neurosurgery
  • Pharmacology

Background:

  • Post-neurosurgical infections, particularly meningitis, are severe complications affecting approximately 4% of patients.
  • Coagulase-negative staphylococci (CoNS), especially methicillin-resistant Staphylococcus epidermidis (MRSE), are primary pathogens in these infections.
  • Treatment of multidrug-resistant (MDR) CoNS meningitis presents significant challenges.

Observation:

  • A unique case of post-neurosurgical meningitis caused by MRSE with linezolid resistance (G2576T mutation) and reduced glycopeptide susceptibility is presented.
  • The patient was successfully treated with a combination of high-dose daptomycin (10 mg/kg daily) and trimethoprim/sulfamethoxazole (TMP/SMX).
  • In vitro studies indicated an indifferent interaction between daptomycin and TMP/SMX.

Findings:

  • Daptomycin achieved therapeutic concentrations in both serum (18.9 mg/L) and cerebrospinal fluid (CSF) (0.78 mg/L) after multiple doses.
  • The calculated blood-brain barrier penetration rate for daptomycin was approximately 5-6% in the inflamed state.
  • The combination therapy demonstrated efficacy in resolving the MRSE meningitis.

Implications:

  • High-dose daptomycin combined with TMP/SMX is a viable treatment strategy for meningitis caused by MDR Staphylococcus epidermidis.
  • Further research is warranted to validate this therapeutic approach in a broader patient population.
  • This case highlights the importance of considering alternative antibiotic combinations for challenging neurosurgical infections.

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