• Goro Nagashima, Noriyoshi Okamoto, Muneo Okuda, Koji Nakashima, Masayuki Noda, Hiroshi Itokawa, Ryuta Suzuki, Tsukasa Fujimoto, and Kenji Marumo.
• Department of Neurosurgery, Fujigaoka Hospital, Showa University, 1-30 Fujigaoka, Yokohama, Kanagawa, 227-8501, Japan. goro-n@pol.dti2.ne.jp
• J. Infect. Chemother. 2008 Apr 1;14(2):147-50.

AbstractA 67-year-old man who had twice previously undergone operations for a tuberculum sellae meningioma was admitted to hospital for further treatment. After the third surgical intervention, the patient developed persistent low-grade fever and impaired consciousness. Computed tomography, 1 week after surgery, showed postsurgical hydrocephalus. Cerebrospinal fluid (CSF) studies revealed high intracranial pressure (above 30 cm H2O), and increased cell count (1232/3). One week after the ventricular drainage, coagulase-negative Staphylococcus epidermidis was recovered from his CSF, and antimicrobial susceptibility results indicated that the organism was methicillin-resistant. After 14 days of intravenous vancomycin (VCM) administration failed, linezolid (LZD) was initialized intravenously, resulting in a resolution of the meningitis. After a ventriculoperitoneal shunt procedure was performed, LZD was continued orally, which resulted in a cure. CSF penetration by VCM is reported to be poor, i.e., approximately 10% of serum concentration, which may explain its lack of efficacy. In this case, the penetration of LZD into the CSF was 58.9% of the peak value and 133% of the trough value of serum concentrations. LZD must be considered one of the first-line treatments against surgical-site infection in neurosurgery caused by methicillin-resistant Staphylococci.

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