Catheter-Associated Vancomycin-Resistant Enterococcus faecium Ventriculitis and Multidrug-Resistant Acinetobacter...

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Neurocritical Care

Background:

• Ventriculitis, an inflammation of the brain's ventricles, is often associated with cerebrospinal fluid (CSF) shunts.
• Infections caused by rare microorganisms such as vancomycin-resistant Enterococcus faecium (VRE faecium) and multidrug-resistant (MDR) Acinetobacter baumannii pose significant treatment challenges due to antimicrobial resistance.
• A lack of established treatment guidelines exists for ventriculitis involving VRE faecium or MDR Acinetobacter baumannii.

Observation:

• A case study involving a 59-year-old male with concurrent VRE faecium ventriculitis and MDR Acinetobacter baumannii pneumonia is presented.
• The patient subsequently developed nosocomial MDR Acinetobacter baumannii ventriculitis, indicating the potential for cross-infection and progression of resistant organisms.
• Initial treatment of MDR Acinetobacter baumannii pneumonia with cefiderocol monotherapy was unsuccessful.

Findings:

• VRE faecium ventriculitis was effectively treated with a combination of linezolid and intrathecal daptomycin, demonstrating a synergistic effect despite daptomycin's non-approved status for enterococcal infections.
• MDR Acinetobacter baumannii ventriculitis was successfully managed using a combination regimen including cefiderocol, ampicillin/sulbactam, and intrathecal colistin.
• These findings highlight the efficacy of tailored combination antibiotic therapies in combating rare and extensively drug-resistant pathogens in the central nervous system.

Implications:

• The successful treatment of rare and MDR ventriculitis underscores the critical role of combination antibiotic strategies in neurocritical care.
• This case provides valuable insights into potential therapeutic options for life-threatening infections caused by VRE faecium and MDR Acinetobacter baumannii.
• Further research into synergistic antibiotic combinations is warranted to establish evidence-based guidelines for managing these challenging nosocomial infections.