Multidrug-Resistant Staphylococcus epidermidis Ventriculostomy-Related Infection Successfully Treated by Intravenous Ceftaroline after Failure of Daptomycin Treatment.
Administration, Intravenous
Aged
Anti-Bacterial Agents
/ administration & dosage
Cephalosporins
/ administration & dosage
Daptomycin
/ administration & dosage
Drug Resistance, Multiple, Bacterial
Female
Humans
Retreatment
Staphylococcal Infections
/ drug therapy
Staphylococcus epidermidis
Surgical Wound Infection
/ drug therapy
Ventriculostomy
Ceftaroline
CSF
Ceftaroline
Daptomycin
External ventricular drain
Multidrug-resistant bacteria
Ventriculostomy-related infection
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
22
10
2019
revised:
02
01
2020
accepted:
03
01
2020
pubmed:
14
1
2020
medline:
9
4
2020
entrez:
14
1
2020
Statut:
ppublish
Résumé
Ventriculostomy-related infection with multidrug-negative strains are challenging to treat. We report the use of new antibiotics in such a case. We report the case of a neurosurgical intensive care unit patient who developed ventriculostomy-related infection with a multidrug-resistant Staphylococcus epidermidis. Vancomycin, recommended in such cases, was not used due to high minimal inhibitory concentrations and concerns for lack of pharmacokinetic/pharmacodynamic target attainment. Daptomycin and ceftaroline remained the only treatment options. Daptomycin was shown microbiologically ineffective after 10 treatment days, with undetectable cerebrospinal fluid (CSF) concentration. Ceftaroline, a novel beta-lactam agent to which the strain showed susceptibility, was thus used. Serum and CSF samples were assessed for antibiotic concentrations. Our results show that CSF bacterial clearance was obtained after 6 days of such treatment. Serum and CSF samplings showed low penetration ratios (2.6%-4.8%), probably due to mild inflammatory CSF profile, with CSF concentration at minimal inhibitory concentration level. We observed than even in the case of mild meningeal inflammation, ceftaroline penetration in CSF, although moderate, enabled efficient bacterial clearance and clinical efficacy, in adjunction to correct ventriculoperitoneal shunt management.
Sections du résumé
BACKGROUND
BACKGROUND
Ventriculostomy-related infection with multidrug-negative strains are challenging to treat. We report the use of new antibiotics in such a case.
CASE DESCRIPTION
METHODS
We report the case of a neurosurgical intensive care unit patient who developed ventriculostomy-related infection with a multidrug-resistant Staphylococcus epidermidis. Vancomycin, recommended in such cases, was not used due to high minimal inhibitory concentrations and concerns for lack of pharmacokinetic/pharmacodynamic target attainment. Daptomycin and ceftaroline remained the only treatment options. Daptomycin was shown microbiologically ineffective after 10 treatment days, with undetectable cerebrospinal fluid (CSF) concentration. Ceftaroline, a novel beta-lactam agent to which the strain showed susceptibility, was thus used. Serum and CSF samples were assessed for antibiotic concentrations. Our results show that CSF bacterial clearance was obtained after 6 days of such treatment. Serum and CSF samplings showed low penetration ratios (2.6%-4.8%), probably due to mild inflammatory CSF profile, with CSF concentration at minimal inhibitory concentration level.
CONCLUSIONS
CONCLUSIONS
We observed than even in the case of mild meningeal inflammation, ceftaroline penetration in CSF, although moderate, enabled efficient bacterial clearance and clinical efficacy, in adjunction to correct ventriculoperitoneal shunt management.
Identifiants
pubmed: 31931253
pii: S1878-8750(20)30020-6
doi: 10.1016/j.wneu.2020.01.013
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Cephalosporins
0
Daptomycin
NWQ5N31VKK
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
221-225Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.