Intrathecal daptomycin use in a challenging case of Enterococcus faecium ventriculitis

Area of Science:

• Infectious Diseases
• Neurosurgery
• Pharmacology

Background:

• Ventriculitis, an infection of the cerebrospinal fluid spaces, poses significant treatment challenges, particularly when caused by multidrug-resistant organisms.
• Enterococcal infections, especially vancomycin-resistant Enterococcus faecium (VRE), are associated with high morbidity and mortality.
• Device-related infections, such as those associated with ventriculo-peritoneal shunts, complicate management and necessitate targeted therapeutic strategies.

Observation:

• A case of device-related ventriculitis caused by vancomycin-resistant Enterococcus faecium (VRE) is presented.
• The infection was refractory to initial standard antibiotic therapies, highlighting the limitations of conventional treatment options.
• The patient had a ventriculo-peritoneal shunt in place, increasing the complexity of the infection and its management.

Findings:

• Intrathecal daptomycin was administered as a salvage therapy due to the failure of other antibiotics.
• The patient tolerated intrathecal daptomycin without any attributable adverse events.
• Following shunt insertion and cessation of antibiotics, the patient remained infection-free, indicating successful treatment.

Implications:

• Intrathecal daptomycin represents a viable and safe therapeutic option for refractory device-related ventriculitis caused by VRE.
• This case expands the understanding of treatment strategies for challenging central nervous system infections.
• Further research into the efficacy and safety of intrathecal daptomycin for similar infections is warranted.