title: Case report of a 6-year-old girl with Mycoplasma hominis ventriculoperitoneal shunt infection.
abstract: Mycoplasma hominis is a rare causative pathogen for surgical site infections after neurosurgical procedures. This organism lacks a cell wall, rendering it undetectable by Gram staining and making it resistant to beta-lactam antibiotics. In addition, some special techniques are required to identify this organism. Thus, it is very difficult to diagnose infections caused by this pathogen. Here, the authors report a pediatric case of M. hominis ventriculoperitoneal shunt (VPS) infection with central nervous system involvement for which beta-lactam antibiotics were not effective and Gram staining revealed no pathogens. Because few cases have been described that involve the treatment of M. hominis infection after neurosurgery, in this case the patient's serum and CSF were monitored for antibiotic drug concentrations. Successful treatment of the infection was achieved after approximately 6 weeks of administration of clindamycin and ciprofloxacin antibiotics in addition to external ventricular drain revision and subsequent VPS replacement. When beta-lactam antibiotics are ineffective and when Gram staining cannot detect the responsible pathogens, it is important to consider M. hominis as the atypical pathogen.
authors.affiliation: Departments of 1 Pediatric Intensive Care.
authors.forename: Masanori
authors.initials: M
authors.lastname: Sato
authors.affiliation: Laboratory Medicine.
authors.forename: Noriko
authors.initials: N
authors.lastname: Kubota
authors.affiliation: Department of Pharmacy, Shinshu University Hospital, Nagano, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Katsuyama
authors.affiliation: Neurosurgery, and.
authors.forename: Yota
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Neurosurgery, and.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Miyairi
authors.affiliation: General Pediatrics, Nagano Children's Hospital; and.
authors.forename: Kisei
authors.initials: K
authors.lastname: Minami
authors.affiliation: Departments of 1 Pediatric Intensive Care.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kasai
mesh_terms: D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D009175:Mycoplasma Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D019535:Mycoplasma hominis; D019635:Neurosurgical Procedures / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
keywords: CNS = central nervous system; ETV = endoscopic third ventriculostomy; EVD = external ventricular drain; Gram staining; MIC = minimum inhibitory concentration; Mycoplasma hominis; PCR = polymerase chain reaction; SSI = surgical site infection; VPS = ventriculoperitoneal shunt; central nervous system infection; ventriculoperitoneal shunt infection