title: PCR and electrospray ionization mass spectrometry for detection of persistent enterococcus faecalis in cerebrospinal fluid following treatment of postoperative ventriculitis.
abstract: We describe the use of PCR and electrospray ionization followed by mass spectrometry (PCR/ESI-MS) to evaluate "culture-negative" cerebrospinal fluid (CSF) from a 67-year-old man who developed postoperative bacterial ventriculitis following a suboccipital craniotomy for resection of an ependymoma in the 4th ventricle. CSF samples were obtained on seven occasions, beginning in the operating room at the time of insertion of a right ventriculoperitoneal shunt (VPS) and continuing until his death, 6 weeks later. During the course of the illness, two initial CSF specimens taken before the initiation of antimicrobial treatment were notable for growth of Enterococcus faecalis. Once antimicrobial treatment was initiated, all CSF cultures were negative. PCR/ESI-MS detected genetic evidence of E. faecalis in all CSF samples, but the level of detection (LOD) decreased once antimicrobial treatment was initiated. When our patient returned with symptoms of meningitis 3 days after the completion of antibiotic treatment, CSF cultures remained negative, but PCR/ESI-MS again found genetic evidence for E. faecalis at levels comparable to the pretreatment levels seen initially. This unique case and these findings suggest that determination of CSF LOD by PCR/ESI-MS may be a very sensitive indicator of persistent infection in patients on antibiotic therapy for complex CNS infections and may have relevance for treatment duration and assessment of persistent or recurrent infection at the completion of therapy.
authors.affiliation: University of Illinois School of Medicine, Department of Medicine, Peoria, Ilinois, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Farrell
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tsung
authors.forename: Lisa
authors.initials: L
authors.lastname: Flier
authors.forename: Derek L
authors.initials: DL
authors.lastname: Martinez
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Beam
authors.forename: Clifford
authors.initials: C
authors.lastname: Chen
authors.forename: Kristin S
authors.initials: KS
authors.lastname: Lowery
authors.forename: Rangarajan
authors.initials: R
authors.lastname: Sampath
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D058565:Cerebral Ventriculitis / Q000188:drug therapy / Q000382:microbiology*; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D016903:Drug Monitoring; D013293:Enterococcus faecalis / Q000737:chemistry / Q000235:genetics / Q000302:isolation & purification*; D017809:Fatal Outcome; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications; D021241:Spectrometry, Mass, Electrospray Ionization; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents
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