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High-Dosage Cefazolin Achieves Sufficient Cerebrospinal Diffusion To Treat an External Ventricular Drainage-Related

Matthieu Grégoire1,2, Benjamin Gaborit3,4, Colin Deschanvres3

  • 1Clinical Pharmacology Department, CHU Nantes, Nantes, France matthieu.gregoire@chu-nantes.fr.

Antimicrobial Agents and Chemotherapy
|November 14, 2018
PubMed

Insights

High-dose cefazolin effectively treats ventriculitis caused by methicillin-susceptible Staphylococcus aureus (MSSA). Cerebrospinal fluid cefazolin concentrations remained above the minimum inhibitory concentration, supporting its use in central nervous system infections.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Neurosurgery

Background:

  • External ventricular drains (EVDs) can be complicated by ventriculitis, often caused by Staphylococcus aureus.
  • Methicillin-susceptible Staphylococcus aureus (MSSA) ventriculitis requires effective antibiotic penetration into the cerebrospinal fluid (CSF).
  • Optimizing antibiotic dosing for CNS infections is crucial for treatment success.

Observation:

  • A patient with EVD-related MSSA ventriculitis was treated with continuous infusion cefazolin (10g then 8g daily).
  • CSF cefazolin concentrations were monitored throughout the treatment course.
  • Clinical and microbiological outcomes were assessed.

Findings:

  • Median CSF cefazolin concentrations were 11.9 mg/L (10g dose) and 6.1 mg/L (8g dose).
  • Free CSF cefazolin concentrations consistently exceeded the minimum inhibitory concentration (MIC) for the infecting MSSA isolate.
  • The patient demonstrated a positive clinical response to high-dose cefazolin therapy.

Implications:

  • High-dose cefazolin is a viable therapeutic option for managing MSSA ventriculitis.
  • Continuous infusion cefazolin can achieve adequate CSF penetration for CNS infections.
  • These findings support the use of cefazolin in treating neurosurgical infections caused by susceptible organisms.
Keywords:
cefazolincerebrospinal fluidhealthcare-associated infectionmeningitispharmacokinetics

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