Multidrug-Resistant Staphylococcus epidermidis Ventriculostomy-Related Infection Successfully Treated by Intravenous Ceftaroline after Failure of Daptomycin Treatment

• Published in: World neurosurgery 2020-04, Vol.136, p.221-225
• Main Authors: Roujansky, Ariane, Martin, Mathieu, Gomart, Camille, Hulin, Anne, Mounier, Roman
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Aged; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - blood; Anti-Bacterial Agents - cerebrospinal fluid; Ceftaroline; Cephalosporins - administration & dosage; Cephalosporins - blood; Cephalosporins - cerebrospinal fluid; CSF; Daptomycin; Daptomycin - administration & dosage; Drug Resistance, Multiple, Bacterial; External ventricular drain; Female; Humans; Multidrug-resistant bacteria; Retreatment; Staphylococcal Infections - drug therapy; Staphylococcal Infections - etiology; Staphylococcus epidermidis; Surgical Wound Infection - drug therapy; Ventriculostomy; Ventriculostomy-related infection
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2020.01.013

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.