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Treatment of cerebrospinal fluid shunt infections with teicoplanin
M L Fernández Guerrero1, M de Górgolas, R Fernández Roblas
1Division of Infectious Diseases and Neurosurgery, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain.
Abstract:
Intraventricular teicoplanin 10-15 mg was administered daily to three patients with cerebrospinal fluid (CSF) shunt infections due to Staphylococcus epidermidis and Enterococcus faecalis. Teicoplanin concentrations in CSF 24 h after intrathecal injection of the drug exceeded four- to eight-fold the MICs for the infecting microorganisms. CSF cultures rapidly became negative and shunt devices were withdrawn and replaced in the same operative procedure. Intraventricular teicoplanin was well tolerated. No relapses occurred. Teicoplanin may be an alternative to vancomycin for the antimicrobial therapy of CSF shunt infections.
Insights
Intraventricular teicoplanin effectively treated cerebrospinal fluid (CSF) shunt infections caused by Staphylococcus epidermidis and Enterococcus faecalis. This antibiotic demonstrated good tolerability and prevented relapses in patients with these challenging infections.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Pharmacology
Background:
- Cerebrospinal fluid (CSF) shunt infections pose a significant challenge in neurosurgery.
- Staphylococcus epidermidis and Enterococcus faecalis are common causative agents of these infections.
- Effective antimicrobial therapy is crucial for successful shunt management.
Observation:
- Three patients with CSF shunt infections were treated with intraventricular teicoplanin (10-15 mg daily).
- Teicoplanin achieved high concentrations in CSF, exceeding the minimum inhibitory concentrations (MICs) for the infecting pathogens.
- CSF cultures converted to negative rapidly following treatment.
Findings:
- Intraventricular teicoplanin demonstrated rapid microbiological clearance of CSF shunt infections.
- The treatment was well-tolerated by all patients.
- No instances of relapse were observed during the follow-up period.
Implications:
- Teicoplanin represents a potential alternative to vancomycin for treating CSF shunt infections.
- This approach may simplify the management of shunt infections, allowing for same-stage device removal and replacement.
- Further research could explore the broader utility of intraventricular teicoplanin in neurosurgical infections.