Vancomycin-resistant Enterococcus Faecium Meningitis Research Articles

Development of VRE meningitis due to haematogenous spread while on high-dose daptomycin therapy.

Vancomycin-resistant Enterococcus faecium (VRE) meningitis accounts for only 0.3%-4.0% of bacterial meningitis cases and typically occurs following neurosurgical intervention. We describe a rare case of a patient without neurological devices in situ or a recent neurological procedure who developed VRE meningitis via haematogenous spread. Optimal treatment for VRE meningitis is unknown. A 67-year-old male with end-stage liver failure underwent liver transplantation complicated by VRE bacteraemia and subsequently developed VRE meningitis while on high-dose daptomycin therapy (12 mg/kg/day). Due to clinical and microbiological failure with daptomycin, he was switched to linezolid and symptoms resolved rapidly. He completed 2 weeks of linezolid, fully recovered, and continued to do well without complications at the 5 month follow-up. This case highlights the severity of VRE infections in solid organ transplant recipients and raises concerns about daptomycin penetration into the CNS. Linezolid could be considered the preferred treatment for VRE CNS infections rather than high-dose daptomycin.

Vancomycin-Resistant Enterococcal Meningitis, Disseminated Strongyloidiasis, and Hypogammaglobulinemia

Abstract The role of immunoglobulins in control of strongyloidiasis has not been well appreciated. This case of disseminated strongyloidiasis with vancomycin-resistant Enterococcus faecium meningitis illustrates the critical role of immunoglobulins in preventing the Strongyloides hyperinfection syndrome.

Vancomycin-resistant Enterococcus faecium meningitis in adults: Case series and review of the literature

Vancomycin-resistant Enterococcus faecium (VR E. faecium) is a rare cause of meningitis and is associated with substantial mortality. Limited therapeutic options are available for the treatment of VR E. faecium meningitis. The optimum therapy has not been established. We retrospectively identified adult cases of meningitis due to VR E. faecium that occurred at the Massachusetts General Hospital from 1999 to 2011 and performed a literature search for published adult cases using Medline and Embase. At our institution, 4 cases of meningitis due to VR E. faecium were identified. Three out of our 4 cases were successfully treated with linezolid in combination with rifampicin, or with daptomycin in combination with quinupristin-dalfopristin (QD), and 1 out of 4 with linezolid monotherapy. The literature search yielded 18 cases published to date. Published cases showed bacterial cure with linezolid, chloramphenicol or QD (intravenous (IV) and intrathecal (IT)) monotherapy, or linezolid in combination with ampicillin, gentamicin, rifampicin or chloramphenicol, or daptomycin in combination with gentamicin or QD. Bacterial cure of meningitis due to VR E. faecium can be achieved with various antimicrobial drugs used as monotherapy or in combination. IT in addition to IV therapy should be considered dependent on the pharmacological properties of the drugs. We also reported the successful treatment of a case with a vancomycin-resistant, linezolid-intermediate isolate with QD and daptomycin. The paucity of cases with this clinical syndrome does not allow the identification of an optimal treatment regimen.

Vancomycin-Resistant Enterococcus faecium Meningitis Successfully Treated With Daptomycin in Combination With Doxycycline and Linezolid

Vancomycin-Resistant Enterococcus faecium Meningitis Successfully Treated With Daptomycin in Combination With Doxycycline and Linezolid

Treatment of Meningitis Caused by Vancomycin-Resistant Enterococcus faecium: High-Dose and Combination Daptomycin Therapy

To report 3 successful treatments of vancomycin-resistant Enterococcus faecium meningitis in adults using daptomycin and either linezolid or gentamicin. Three case reports involving males (aged 58-78 years) are presented; in each case (trigeminal nerve microvascular decompression and subdural hygroma; paraspinal abscess; and hydrocephalus with subsequent craniotomy and ventriculo-peritoneal shunt placement) CSF examination revealed vancomycin-resistant Enterococcus (VRE) susceptible to daptomycin, gentamicin, and/or linezolid. Threeto four-week treatment regimens with daptomycin 6-12 mg/kg and either gentamicin or linezolid led to clinical resolution and microbiological clearance of infection. Daptomycin has previously been shown to be successful in treating methicillin-resistant Staphylococcus aureus-associated meningitis and other serious VRE and enterococcal infections. Higher than approved doses of daptomycin were used in 2 cases where in theory higher CSF concentrations would thus be obtained. Gentamicin and linezolid were added to daptomycin therapy based on in vitro data synergy results and because of documented successful treatment for VRE meningitis, respectively. The difficulty in treating VRE CSF infections involves both drug kinetics and microbial resistance factors, as well as external factors such as foreign bodies like shunts. This report highlighted 3 cases where daptomycin use in concert with either gentamicin or linezolid was successful in treating this infection. Additional controlled trials will be helpful in identifying the best strategies when using daptomycin to treat CSF infections.

Superficial Flaccid Bullae in a Female Neonate—Quiz Case

A 58-year-old woman presented with Escherichia coli bacteremia, vancomycin-resistant Enterococcus faecium meningitis, and septic shock. Before this presentation, she had received systemic corticosteroids on 3 separate occasions at another hospital for exacerbations of chronic obstructive pulmonary disease as a result of 1-antitrypsin disease. Physical examination revealed an extensive purpuric rash on her abdomen (Figure1) and the anterior aspect of her thighs.Shediedshortlyafterward.Sectionsof skinobtained atautopsyshowedparasiticorganismsinthesuperficialdermis (Figure 2 and Figure 3) and subcutaneous fat. What is your diagnosis?

Vancomycin-ResistantEnterococcus faeciumMeningitis Treated with Linezolid: A Case Report and Review of the Literature

Vancomycin-Resistant<i>Enterococcus faecium</i>Meningitis Treated with Linezolid: A Case Report and Review of the Literature

Vancomycin-resistant Enterococcus faecium Meningitis Successfully Treated with Linezolid

Vancomycin-resistant Enterococcus faecium Meningitis Successfully Treated with Linezolid

Minor emtricitabine intolerance in treatment-stable patients switched from tenofovir/lamivudine to a fixed-dose combination of tenofovir/emtricitabine (Truvada(R))

1. Infection in Neurosurgery Working Party of the British Society for Antimicrobial Chemotherapy. The management of neurosurgical patients with postoperative bacterial or aseptic meningitis or external ventricular drain-associated ventriculitis. Br J Neurosurg 2000; 14: 7–12. 2. Shaikh ZH, Peloquin CA, Ericsson CD. Successful treatment of vancomycin-resistant Enterococcus faecium meningitis with linezolid; case report and literature review. Scand J Infect Dis 2001; 33: 375–9. 3. Graham PL, Ampofo K, Saiman L. Linezolid treatment of vancomycin-resistant Enterococcus faecium ventriculitis. Pediatr Infect Dis J 2002; 21: 798–800. 4. Huovinen P, Kotilainen P. In vitro activity of a new cyclic lipopeptide antibiotic, LY146032, against Gram-positive clinical bacteria. Antimicrob Agents Chemother 1987; 31: 455–7. 5. Cottagnoud P, Pfister M, Acosta F et al. Daptomycin is highly efficacious against penicillin-resistant and penicillinand quinoloneresistant pneumococci in experimental meningitis. Antimicrob Agents Chemother 2004; 48: 3928–33. 6. Haworth CS, Sobieski MW, Scheld M et al. Staphylococcus aureus ventriculitis treated with single-dose vancomycin or daptomycin (LY146032): bacterial and antibiotic kinetics in hydrocephalic rabbits. Antimicrob Agents Chemother 1990; 34: 245–51.

First Confirmed Case of Vancomycin-Resistant Enterococcus faecium Meningitis in Turkey:

Vancomycin-resistant enterococci are unusual etiologic agents of bacterial meningitis and pose significant therapeutic difficulties. We report the first con-firmed case of nosocomial vancomycin-resistant Enterococcus faecium meningitis in Turkey. The patient was treated with chloramphenicol and cerebrospinal fluid cultures became negative, but clinical success was not achieved. We also review the previously reported cases of vancomycin-resistant Enterococcus faecium meningi-tis.

Vancomycin-resistant Enterococcus faecium meningitis in a patient with underlying strongloidiasis

Vancomycin-resistant Enterococcus faecium meningitis in a patient with underlying strongloidiasis