title: [Two cases of methicillin-resistant Staphylococcus aureus (MRSA) sepsis following craniotomy].
abstract: We report here two cases of MRSA sepsis following craniotomy. In case 1, a petroclival meningioma was subtotally removed and lumbar drainage was inserted postoperatively to prevent cerebrospinal fluid leakage. Ventriculo-peritoneal shunt was performed after meningitis was treated with vancomycin and panipenem/betamipron. Two weeks after the procedure, the patient revealed continuous spiking fevers related to MRSA sepsis, which did not improve with vancomycin and arbekacin administration. The focus of infection was found by scintigraphy and CT by 67Ga to be spondylo-diskitis at the level of L2-L3. The lesion was removed and bone from the iliac crest grafted. In case 2, seven days after surgery for multiple meningioma, the patient exhibited spiking fevers and swelling in the left leg. The central venous catheter was removed from the left femoral vein and MRSA was found from blood culture. The patient was treated with arbekacin (200 mg/day). Venous thrombosis diagnosed by CT was treated with heparin. Symptoms related to the infection and laboratory data did not improve because the concentration of arbekacin in the blood did not reach an effective level. The symptoms markedly improved when the dose of arbekacin was doubled (400 mg/day).
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University.
authors.forename: H
authors.initials: H
authors.lastname: Kasuya
authors.forename: K
authors.initials: K
authors.lastname: Kikuchi
authors.forename: T
authors.initials: T
authors.lastname: Imamura
authors.forename: A
authors.initials: A
authors.lastname: Kawashima
authors.forename: Y
authors.initials: Y
authors.lastname: Aihara
authors.forename: T
authors.initials: T
authors.lastname: Ochiai
authors.forename: K
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: K
authors.initials: K
authors.lastname: Fukamachi
authors.forename: T
authors.initials: T
authors.lastname: Hori
authors.forename: M
authors.initials: M
authors.lastname: Shiseki
authors.forename: K
authors.initials: K
authors.lastname: Tozuka
mesh_terms: D000328:Adult; D000368:Aged; D000409:Alanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000617:Aminoglycosides; D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003399:Craniotomy; D003982:Dibekacin / Q000008:administration & dosage / Q000031:analogs & derivatives; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D016106:Methicillin Resistance; D011183:Postoperative Complications; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000628:therapy*; D013407:Sulbactam / Q000008:administration & dosage; D013845:Thienamycins / Q000008:administration & dosage; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D013845:Thienamycins; C047207:N-benzoylalanine; D003982:Dibekacin; C035444:sultamicillin; D014640:Vancomycin; D000667:Ampicillin; C031986:arbekacin; D000409:Alanine; D013407:Sulbactam; C039536:panipenem