title: Successful treatment and cerebrospinal fluid penetration of oral linezolid in a patient with coagulase-negative Staphylococcus ventriculitis.
abstract: OBJECTIVE
  To describe a case of coagulase-negative Staphylococcus ventriculitis successfully treated with oral linezolid, for which good cerebrospinal fluid (CSF) penetration was observed.
  
  
  METHODS
  A 69-year-old man had an extraventricular drain inserted following a right cerebellar infarct. On day 6, the CSF culture was positive for coagulase-negative staphylococci; intravenous vancomycin 1 g daily was initiated to treat ventriculitis. A ventriculoperitoneal shunt, inserted on day 35 to manage communicating hydrocephalus, was subsequently removed as symptoms suggesting infection presented. Coagulase-negative Staphylococcus was isolated from shunt reservoir aspirate, and intrathecal vancomycin 10 mg daily was added to the treatment regimen. On day 61, vancomycin was stopped and oral linezolid 600 mg twice daily was started. Linezolid was discontinued 22 days later, with no evidence of ongoing infection. Four blood samples were collected around the seventh dose of linezolid and 5 CSF samples were collected on separate days during treatment. Linezolid concentrations were measured in plasma and CSF by HPLC. Using an ADAPT II maximum a priori Bayesian estimator module, a 2 compartment pharmacokinetic model was fitted to the plasma linezolid concentration data and CSF:predicted plasma concentration ratios (ranging from 0.27 to 1.02) were derived. All CSF concentrations exceeded the reported 90% minimum inhibitory concentration of 2 mg/L for linezolid against coagulase-negative staphylococci.
  
  
  CONCLUSIONS
  Evidence of the effectiveness of linezolid against central nervous system infections is growing; however, limited data exist describing its CSF penetration. Oral linezolid exhibited good CSF penetration in this patient, which corresponded to positive clinical response.
  
  
  CONCLUSIONS
  Oral linezolid may play a valuable role in the treatment of multiresistant gram-positive central nervous system infections.
authors.affiliation: Facility for Anti-infective Drug Development and Innovation, Department of Pharmacy Practice, Victorian College of Pharmacy, Monash University, Parkville, Australia.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Boak
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.forename: Denis
authors.initials: D
authors.lastname: Spelman
authors.forename: Philipp
authors.initials: P
authors.lastname: du Cros
authors.forename: Roger L
authors.initials: RL
authors.lastname: Nation
authors.forename: Craig R
authors.initials: CR
authors.lastname: Rayner
mesh_terms: D000081:Acetamides / Q000097:blood / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D000284:Administration, Oral; D000368:Aged; D000890:Anti-Infective Agents / Q000097:blood / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D002552:Cerebral Ventricles; D004660:Encephalitis / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D006801:Humans; D000069349:Linezolid; D008297:Male; D023303:Oxazolidinones / Q000097:blood / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology
chemical_list: D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D000069349:Linezolid