Intraventricular Daptomycin and Intravenous Linezolid for the Treatment of External Ventricular-Drain–Associated Ventriculitis Due to Vancomycin-Resistant Enterococcus faecium

Mueller, Scott W.; Kiser, Tyree H.; Anderson, Tracey; Neumann, Robert

doi:10.1345/aph.1r412

Cited by 35 publications

(30 citation statements)

References 17 publications

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“…Antibiotics used for intrathecal or intraventricular route for cases of VRE meningitis/ventriculitis are linezolid, gentamicin, daptomycin, chloramphenicol, and quinupristin/dalfopristin. [1524252627] Removal of infected hardware like VP shunt is also recommended for better treatment outcome. [28] Although reported mortality is high with enterococcal CNS infection,[513] timely initiation of appropriate therapy improves outcomes.…”

Section: Discussionmentioning

confidence: 99%

Enterococcal meningitis/ventriculitis: A tertiary care experience

2019

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Context:Enterococcal meningitis is very rare among bacterial meningitis and has variable clinical outcomes.Aims:The purpose of the current study is to evaluate clinical features, therapeutic options with susceptibility profile, and outcomes of enterococcal meningitis in a tertiary care hospital.Settings and Design:We retrospectively reviewed medical records of all patients with enterococcal meningitis over the periods of 4 years.Subjects and Methods:The clinical and laboratory data of all patients with enterococcal meningitis were evaluated between 2013 and 2016.Results:Six cases of enterococcal meningitis were found (three infant and three adults). All patients developed meningitis after neurosurgical procedures, and majority of patients (four out of six) had central nervous system (CNS) devices in situ at the time of development of meningitis. The causative organism isolated from cerebrospinal fluid (CSF) culture of all patients was Enterococcus species only. All Enterococcus spp. were resistant to ampicillin, Amoxicillin-clavulanate, and oxytetracycline and two isolates were also resistant to vancomycin. Four patients with vancomycin-sensitive Enterococcus spp. were treated with vancomycin alone for mean periods of 18 days (14–21 days). One patient with vancomycin-resistant Enterococcus (VRE) meningitis was treated with linezolid alone, and another one requires combination with rifampicin to achieve microbiological clearance of CSF. CNS devices were removed in all patients. No mortality was reported in current case series.Conclusions:Enterococcal meningitis is very uncommon, mostly associated with neurosurgical intervention. Early treatment is associated with favorable outcomes. Removal of CNS devices is recommended to achieve a clinical cure.

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Section: Discussionmentioning

confidence: 99%

Enterococcal meningitis/ventriculitis: A tertiary care experience

2019

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“…Teicoplanin, a glycopeptide antimicrobial agent not currently licensed in the United States, was also found to be successful after intraventricular administration in 7 patients with staphylococcal neurosurgical shunt infections [133]. Intraventricular daptomycin was successfully used in individual case reports in patients with CSF shunt and CSF drain infections caused by methicillin-resistant coagulase-negative staphylococci and resistant enterococci [134][135][136][137]. Intraventricular colistin (usually formulated as colistimethate sodium) and polymyxin B have been used in the treatment of gram-negative ventriculitis and meningitis [109,116,119,[138][139][140]; however, these agents should be reserved for patients with infections caused by multidrug-resistant gram-negative bacteria or in those who failed therapy with standard intravenous agents.…”

Section: Evidence Summarymentioning

confidence: 99%

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

698

671

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The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.

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“… 75 Daptomycin administered intraventricularly along with systemic linezolid was successful for the treatment of a CNS infection due to VRE. 94 Daptomycin is a treatment option for IAIs and has been administered intraperitoneally for successful treatment of VRE peritonitis. 95 It achieves high renal clearance at 50%–70%, giving it a favorable profile for the treatment of VRE UTIs.…”

Section: Optimal Managementmentioning

confidence: 99%

Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management

O’Driscoll¹,

Crank²

2015

IDR

294

202

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Since its discovery in England and France in 1986, vancomycin-resistant Enterococcus has increasingly become a major nosocomial pathogen worldwide. Enterococci are prolific colonizers, with tremendous genome plasticity and a propensity for persistence in hospital environments, allowing for increased transmission and the dissemination of resistance elements. Infections typically present in immunosuppressed patients who have received multiple courses of antibiotics in the past. Virulence is variable, and typical clinical manifestations include bacteremia, endocarditis, intra-abdominal and pelvic infections, urinary tract infections, skin and skin structure infections, and, rarely, central nervous system infections. As enterococci are common colonizers, careful consideration is needed before initiating targeted therapy, and source control is first priority. Current treatment options including linezolid, daptomycin, quinupristin/dalfopristin, and tigecycline have shown favorable activity against various vancomycin-resistant Enterococcus infections, but there is a lack of randomized controlled trials assessing their efficacy. Clearer distinctions in preferred therapies can be made based on adverse effects, drug interactions, and pharmacokinetic profiles. Although combination therapies and newer agents such as tedizolid, telavancin, dalbavancin, and oritavancin hold promise for the future treatment of vancomycin-resistant Enterococcus infections, further studies are needed to assess their possible clinical impact, especially in the treatment of serious infections.

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Intraventricular Daptomycin and Intravenous Linezolid for the Treatment of External Ventricular-Drain–Associated Ventriculitis Due to Vancomycin-Resistant Enterococcus faecium

Abstract: Intraventricular daptomycin may be an option for EVD-associated VRE infections that do not respond to conventional therapy. Intraventricular daptomycin 5 mg is a reasonable initial dose in adults with VRE ventriculitis, based on our experience in this patient.

Cited by 35 publications

References 17 publications

Enterococcal meningitis/ventriculitis: A tertiary care experience

Enterococcal meningitis/ventriculitis: A tertiary care experience

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management

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