Use of Intraventricular Vancomycin in Neonatal Meningitis due to Elizabethkingilla meningoseptica

Abstract

Elizabethkingia meningoseptica is a non-motile, catalase positive, oxidase positive, non-glucose fermenting, gram negative bacilli which is resistant to common drugs active against gram negative organism. It manifests mainly as meningitis in newborns especially in preterms that are immune compromised. Antibiotics which have shown effectiveness against this organism includes cotrimoxazole, tigecycline, minocycline, quinolones, piperacillin, tazobactam, cefepime and drugs active against gram positive bacteria such as vancomycin and rifampicin. The major reason for the cautioned use of Intraventricular/Intrathecal therapy has been the significant toxicity that was reported by earlier studies. These included seizures in up to 20% of the patients and chemical ventriculitis in as high as 60% of the patients, though those were considered to be dose related. Few papers have also reported side effects such as transient hearing loss and seizures. Here we report a preterm newborn having E. meningoseptica ventriculitis showing improvement with intraventricular vancomycin without any short term adverse effect in first 6 months of life.