Effect of linezolid against postneurosurgical meningitis caused by methicillin-resistant Staphylococcus epidermidis: case report.
A 67-year-old man who had twice previously undergone operations for a tuberculum sellae meningioma was admitted to hospital for further treatment. After the third surgical intervention, the patient developed persistent low-grade fever and impaired consciousness. Computed tomography, 1 week after surgery, showed postsurgical hydrocephalus. Cerebrospinal fluid (CSF) studies revealed high intracranial pressure (above 30 cm H2O), and increased cell count (1232/3). One week after the ventricular drainage, coagulase-negative Staphylococcus epidermidis was recovered from his CSF, and antimicrobial susceptibility results indicated that the organism was methicillin-resistant. After 14 days of intravenous vancomycin (VCM) administration failed, linezolid (LZD) was initialized intravenously, resulting in a resolution of the meningitis. After a ventriculoperitoneal shunt procedure was performed, LZD was continued orally, which resulted in a cure. CSF penetration by VCM is reported to be poor, i.e., approximately 10% of serum concentration, which may explain its lack of efficacy. In this case, the penetration of LZD into the CSF was 58.9% of the peak value and 133% of the trough value of serum concentrations. LZD must be considered one of the first-line treatments against surgical-site infection in neurosurgery caused by methicillin-resistant Staphylococci.
Nagashima
Goro
G
Department of Neurosurgery, Fujigaoka Hospital, Showa University, 1-30 Fujigaoka, Yokohama, Kanagawa, 227-8501, Japan. goro-n@pol.dti2.ne.jp
Okamoto
Noriyoshi
N
Okuda
Muneo
M
Nakashima
Koji
K
Noda
Masayuki
M
Itokawa
Hiroshi
H
Suzuki
Ryuta
R
Fujimoto
Tsukasa
T
Marumo
Kenji
K
D000081:Acetamides / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D000069349:Linezolid; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D016106:Methicillin Resistance; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D023303:Oxazolidinones / Q000008:administration & dosage / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology; D013212:Staphylococcus epidermidis / Q000187:drug effects*; D016896:Treatment Outcome
D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D000069349:Linezolid