title: Is First-Line Vancomycin Still the Best Option to Treat Staphylococcus Health Care-Associated Meningitis?
abstract: BACKGROUND
  Cerebrospinal fluid (CSF) penetration of vancomycin through the blood-brain barrier is poor but important inflammation improved it. Hence, vancomycin is recommended for the treatment of community meningitis. However, what about mild inflammatory health care-associated meningitis? The aim of this study was to evaluate the impact of vancomycin diffusion on CSF in Staphylococcus epidermidis health care-associated meningitis.
  
  
  METHODS
  This was a retrospective study of all consecutive patients with S. epidermidis CSF shunt-associated infection, which was treated by continuous intravenous vancomycin after standard of care (60 mg/kg/d after a loading dose of 15 mg/kg). Patient outcome, CSF protein level, and vancomycin concentration in CSF and serum were assessed. We report 6 consecutives cases. Clinical and biologic manifestations were of mild intensity. Meningeal permeability was moderately altered with low CSF protein levels. Despite appropriate vancomycin dosage resulting in high serum concentrations, CSF remained below the S. epidermidis minimal inhibitory concentration.
  
  
  CONCLUSIONS
  We propose to reassess vancomycin use as first-line therapy when meningeal inflammation is mild-to-moderate in favor of antibiotics, which have a better CSF penetration.
authors.affiliation: Anaesthesia and Surgical Intensive Care Unit Department, Henri Mondor University Hospital of Paris-Paris XII School of Medicine, Creteil, France. Electronic address: roman.mounier@hmn.aphp.fr.
authors.forename: Roman
authors.initials: R
authors.lastname: Mounier
authors.affiliation: Anaesthesia and Surgical Intensive Care Unit Department, Henri Mondor University Hospital of Paris-Paris XII School of Medicine, Creteil, France.
authors.forename: David
authors.initials: D
authors.lastname: Lobo
authors.affiliation: Pharmacology Laboratory, Biochemistry-Pharmacology Department, Henri Mondor University Hospital of Paris-Paris XII School of Medicine, Creteil, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Hulin
authors.affiliation: Bacteriology Laboratory, Microbiology Department, Henri Mondor University Hospital of Paris-Paris XII School of Medicine, Creteil, France.
authors.forename: Biba
authors.initials: B
authors.lastname: Nebbad
authors.affiliation: Anaesthesia and Surgical Intensive Care Unit Department, Henri Mondor University Hospital of Paris-Paris XII School of Medicine, Creteil, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Cook
authors.affiliation: Anaesthesia and Surgical Intensive Care Unit Department, Henri Mondor University Hospital of Paris-Paris XII School of Medicine, Creteil, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dhonneur
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000188:drug therapy*; D002557:Cerebrospinal Fluid Shunts; D003428:Cross Infection / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013212:Staphylococcus epidermidis; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Cerebrospinal fluid; Health care–associated meningitis; Inflammation; Low pathogen; Meningitis; S. epidermidis; Vancomycin