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Vancomycin and rifampin therapy for Staphylococcus epidermidis meningitis associated with CSF shunts: report of three
Abstract:
Three patients with Staphylococcus epidermis meningitis associated with cerebrospinal fluid (CSF) shunt devices were treated with a combination of intravenous vancomycin and oral rifampin. Two of the isolates were methicillin-resistant. All patients had a favorable clinical response. Time-kill curves showed that the addition of rifampin to vancomycin resulted in enhanced bactericidal activity against all isolates when compared to either antibiotic alone. This finding suggests that the combination of oral rifampin and intravenous vancomycin may be useful in the treatment of methicillin-resistant and recalcitrant methicillin-sensitive S. epidermis meningitis associated with CSF shunts. In vitro susceptibility testing should be performed.
Insights
Vancomycin combined with rifampin effectively treated Staphylococcus epidermis meningitis in patients with cerebrospinal fluid (CSF) shunts. This combination demonstrated enhanced bacterial killing, suggesting its utility for resistant infections.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Pharmacology
Background:
- Staphylococcus epidermis meningitis is a serious complication associated with cerebrospinal fluid (CSF) shunts.
- Treatment of shunt-associated meningitis, particularly with methicillin-resistant strains, presents a clinical challenge.
Observation:
- Three patients with S. epidermis meningitis and CSF shunts received combined intravenous vancomycin and oral rifampin.
- Two of the S. epidermis isolates were confirmed as methicillin-resistant.
- All patients achieved a favorable clinical outcome following the treatment regimen.
Findings:
- Time-kill studies revealed that the combination of vancomycin and rifampin exhibited enhanced bactericidal activity against S. epidermis isolates compared to monotherapy.
- The synergistic effect was observed against both methicillin-resistant and methicillin-sensitive S. epidermis strains.
Implications:
- The combination of intravenous vancomycin and oral rifampin shows promise for treating S. epidermis meningitis linked to CSF shunts.
- This therapeutic approach may be particularly beneficial for recalcitrant or methicillin-resistant S. epidermis infections.
- Performing in vitro susceptibility testing is recommended to guide treatment decisions.