• World Neurosurg · Apr 2019

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

    • Ayse Şahin and Nazan Dalgic.
    • Department of Pediatric Infectious Diseases, University of Health Sciences, Sisli Hamidiye Etfal Research and Education Hospital, Istanbul, Turkey. Electronic address: ayseturgutsahin@gmail.com.
    • World Neurosurg. 2019 Apr 1; 124: 328330328-330.

    BackgroundThe rate of ventriculoperitoneal (VP) shunt infection is reported between 3% and 20%. Vancomycin-resistant enterococci (VRE) are increasingly prevalent nosocomial pathogens worldwide, and they rarely cause infections to the central nervous system. Daptomycin is a cyclic lipopeptide effective antibiotic because of its rapid bactericidal effect. It is a life-saving treatment option for meningitis, bacteremia, sepsis, endocarditis, and urinary system infections caused by VRE.Case DescriptionHere, we present a 2.5-month-old infant boy with a ventriculoperitoneal shunt infection caused by vancomycin-resistant Enterococcus faecium. This is the first report of a pediatric VP shunt infection caused by VRE and treated with a combination of intravenous (IV) linezolid IV and intraventricular (IVT) daptomycin.ConclusionThe patient was admitted to the medical center with umbilical discharge, and shunt revision was applied with the thought of shunt dysfunction. Intermittent umbilical cerebrospinal fluid (CSF) leakage continued, and the patient experienced a fever 2 weeks after the operation. VRE growth in his CSF culture was treated by meropenem and linezolid. Upon continuation of the growth afterwards, the patient was referred to our hospital and underwent extraventricular drainage, and IV linezolid, IV daptomycin (8 mg/kg per day), and IVT daptomycin (2.5 mg/kg per day) was scheduled as treatment. On the fifth day of treatment, there was no growth in the culture, and no side effects were observed during the treatment. A VP shunt was placed in the patient for the 15 days of IV daptomycin plus IVT treatment, and 36 days of linezolid. No infection was observed in the 8-month follow-up period.Copyright © 2019 Elsevier Inc. All rights reserved.

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