Sterilization of Ommaya reservoir by instillation of vancomycin

We describe the management of a patient with a Staphylococcus epidermidis infection of an Ommaya reservoir that was being used for the treatment of carcinomatous meningitis. Intravenous vancomycin failed to eradicate the organism. We treated our patient successfully with parenteral antibiotics and local instillation of vancomycin (25 micrograms/ml) without removing the reservoir. The patient tolerated the intraventricular vancomycin well. We recommend this approach in the treatment of infected Ommaya reservoirs in patients who have diseases with extremely poor prognoses and who wish to be discharged from the hospital early.