Use of Daptomycin for the Treatment of Methicillin-Resistant Coagulase-Negative Staphylococcal Ventriculitis

Abstract

Coagulase-negative staphylococci (CoNS) are the main pathogens causing hospital-acquired external-ventricular-drain- (EVD-) and lumbar-drain- (LD-) associated meningitis and ventriculitis. The treatment of these infections can be challenging and may require combination of intraventricular and intravenous administration of antibiotics. Limited animal data demonstrate rapid daptomycin bactericidal activity, adequate penetration in the setting of inflamed meninges, and extended half-life in the ventricles Steenbergen et al. (2009). There are limited clinical data using daptomycin intravenously and/or intraventricularly for the treatment of central nervous system infections (CNS) Elvy et al. (2008), Stucki et al. (2007), Lee et al. (2008) and Wallace et al. (2009). We report here our experience in the treatment of an EVD-related infection.

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

“…One additional case using intravenous and intraventricular daptomycin for coagulase-negative staphylococcal (CoNS) ventriculitis assessed serum and CSF daptomycin concentrations ( Table 2). 16 In the first adult case, 12 days of intraventricular vancomycin with 4 days of concomitant intravenous daptomycin 12 mg/kg daily failed to sterilize the CSF of vancomycin-susceptible E. faecium (VSE). Daptomycin via intraventricular administration was initiated at 10 mg every third day with the assessment of peak and trough CSF concentrations.…”

“…No adverse effects were reported. 16 Antibiotics with low CSF penetration that are unlikely to achieve adequate CSF concentrations at systemic doses are candidates for the intraventricular route. Randomized controlled trials evaluating safety and efficacy of intraventricular antimicrobials are lacking, and intraventricular ad-ministration of antimicrobials is not a route approved by the Food and Drug Administration.…”

“…14 Conversely, in the adult being treated for CoNS, intraventricular daptomycin 10 mg every other day corresponded to a much lower peak concentration. 16 Care should be taken to use the lowest, maximally effective dose when intraventricular antimicrobials are used. For daptomycin, 5 mg is a reasonable initial intraventricular dose; it is unknown whether a lower dose may be as effective, with a lower risk for chemical irritation.…”

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

“…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.…”

Prevención y tratamiento de las infecciones del sitio operatorio en neurocirugía. Estado del arte

“…Con respecto a la elección, las dosis y los intervalos de la administración de antimicrobianos, las decisiones deben tener en consideración el microorganismo aislado y su patrón de resistencia, la neurotoxicidad del agente y la salida diaria de LCR por el drenaje externo (109,(128)(129)(130)(131)(132)(133)(134)(135)(136)(137)(138)(139)(140)(141)(142)(143)(144)(145)(146)(147)(148)…”