Intravenous and intraventricular daptomycin plus intravenous linezolid treatment of an infant with Vancomycin-Resistant Enterococci induced ventriculoperitoneal shunt infection.

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Intravenous and intraventricular daptomycin plus intravenous linezolid treatment of an infant with Vancomycin-Resistant Enterococci induced ventriculoperitoneal shunt infection.

World Neurosurg. 2019 Jan 24;:

Authors: Şahin A, Dalgic N

Abstract
The rate of ventriculoperitoneal (VP) shunt infection is reported between 3% and 20%. Vancomycin-Resistant Enterococci (VRE) are increasingly prevalent nasocomial pathogens worldwide and they rarely cause infections to the central nervous system. Daptomycin is a cyclic lipopeptide effective antibiotic due to its rapid bactericidal effect. It is a life-saving treatment option for meningitis, bacteriemia, sepsis, endocarditis and urinary system infections caused by VRE. Here, we presented a 2.5-month-old male patient diagnosed with ventriculoperitoneal shunt infection caused by VRE faecium. This is the first pediatric VP shunt infection caused by VRE and treated with a combination of intravenous (IV) linezolid IV and intraventricular (IVT) daptomycin. The patient was admitted to the medical center with the complaint of umbilical discharge and shunt revision was applied with the thought of shunt dysfunction. Intermittent umbilical cerebrospinal fluid (CSF) leakage continued and the patient developed fever 2 weeks after the operation. VRE growth in his CSF culture was treated by meropenem and linezolid treatment. Upon continuation of the growth afterwards, the patient who was referred to our hospital underwent extra ventricular drainage (EVD), and IV linezolid, IV daptomycin (8 mg/kg day) and IVT daptomycin (2.5 mg/kg day) was scheduled as treatment. On the 5th day of treatment, there was no growth in the culture and no side effects were observed during the treatment. VP shunt was placed in the patient for the 15 days of daptomycin IV plus IVT treatment, and 36 days of linezolid. No infection was observed in the 8-month follow-up period.

PMID: 30685371 [PubMed - as supplied by publisher]

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