Treatment Optimization by Monitoring Vancomycin Concentration in the Serum and Cerebrospinal Fluid in a Child with Cystoperitoneal Shunt-related Infection Caused by Methicillin-resistant Staphylococcus Aureus: a Case Report and Literature Review

Overview

Journal Childs Nerv Syst

Specialty Pediatrics

Date 2023 Jun 4

PMID 37271777

Authors

Shinsuke Mizuno

Junji Koyama

Hiroshi Kurosawa

Masashi Kasai

Affiliations

Soon will be listed here.

Abstract

Background: Cerebral ventricular shunt infections caused by methicillin-resistant Staphylococcus aureus (MRSA), especially strains with elevated minimum inhibitory concentration (MIC) values, have a poor prognosis. Monitoring serum vancomycin (VCM) levels with therapeutic drug monitoring and maintaining high VCM concentrations in the cerebrospinal fluid (CSF) are critical to treatment success. However, there have been a few reports about the CSF penetration and the pharmacokinetics of VCM in children.

Case Presentation: Here, we report the case of a pediatric patient with cysto-peritoneal shunt-related meningitis caused by MRSA with an MIC of 2 μg/mL. The adequate VCM concentration was maintained by monitoring the VCM concentration in the CSF via the external ventricular drain, and frequent blood taking was avoided. VCM showed a good CSF penetration in our patient, and she was discharged without complications.

Discussion: Therapeutic drug monitoring of VCM concentration in the CSF may result in successful treatment even if MRSA shows a higher MIC. Therapeutic drug monitoring of VCM concentration in the CSF may also reduce the side effects.

References

Autmizguine J, Moran C, Gonzalez D, Capparelli E, Smith P, Grant G . Vancomycin cerebrospinal fluid pharmacokinetics in children with cerebral ventricular shunt infections. Pediatr Infect Dis J. 2014; 33(10):e270-2. PMC: 4209191. DOI: 10.1097/INF.0000000000000385. View

Wilkie M, Hanson M, Statham P, Brennan P . Infections of cerebrospinal fluid diversion devices in adults: the role of intraventricular antimicrobial therapy. J Infect. 2012; 66(3):239-46. DOI: 10.1016/j.jinf.2012.11.006. View

Ichie T, Urano K, Suzuki D, Okada T, Kobayashi N, Hayashi H . Influence of cerebral fluid drainage on the pharmacokinetics of vancomycin in neurosurgical patients. Pharmazie. 2015; 70(6):404-9. View

Jorgenson L, Reiter P, Freeman J, Winston K, Fish D, McBride L . Vancomycin disposition and penetration into ventricular fluid of the central nervous system following intravenous therapy in patients with cerebrospinal devices. Pediatr Neurosurg. 2007; 43(6):449-55. DOI: 10.1159/000108786. View

Kumta N, Roberts J, Lipman J, Cotta M . Antibiotic Distribution into Cerebrospinal Fluid: Can Dosing Safely Account for Drug and Disease Factors in the Treatment of Ventriculostomy-Associated Infections?. Clin Pharmacokinet. 2017; 57(4):439-454. DOI: 10.1007/s40262-017-0588-3. View

Karvouniaris M, Brotis A, Tsiakos K, Palli E, Koulenti D . Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis. Infect Drug Resist. 2022; 15:697-721. PMC: 8896765. DOI: 10.2147/IDR.S326456. View

Scheld W, Dacey R, Winn H, Welsh J, Jane J, Sande M . Cerebrospinal fluid outflow resistance in rabbits with experimental meningitis. Alterations with penicillin and methylprednisolone. J Clin Invest. 1980; 66(2):243-53. PMC: 371704. DOI: 10.1172/JCI109850. View

Ng K, Mabasa V, Chow I, Ensom M . Systematic review of efficacy, pharmacokinetics, and administration of intraventricular vancomycin in adults. Neurocrit Care. 2012; 20(1):158-71. DOI: 10.1007/s12028-012-9784-z. View

Beach J, Perrott J, Turgeon R, Ensom M . Penetration of Vancomycin into the Cerebrospinal Fluid: A Systematic Review. Clin Pharmacokinet. 2017; 56(12):1479-1490. DOI: 10.1007/s40262-017-0548-y. View

10.

Fan-Havard P, Nahata M, Bartkowski M, Barson W, Kosnik E . Pharmacokinetics and cerebrospinal fluid (CSF) concentrations of vancomycin in pediatric patients undergoing CSF shunt placement. Chemotherapy. 1990; 36(2):103-8. DOI: 10.1159/000238755. View

11.

Liu C, Bayer A, Cosgrove S, Daum R, Fridkin S, Gorwitz R . Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011; 52(3):e18-55. DOI: 10.1093/cid/ciq146. View

12.

Wang Q, Shi Z, Wang J, Shi G, Wang S, Zhou J . Postoperatively administered vancomycin reaches therapeutic concentration in the cerebral spinal fluid of neurosurgical patients. Surg Neurol. 2007; 69(2):126-9. DOI: 10.1016/j.surneu.2007.01.073. View

13.

Kalil A, Van Schooneveld T, Fey P, Rupp M . Association between vancomycin minimum inhibitory concentration and mortality among patients with Staphylococcus aureus bloodstream infections: a systematic review and meta-analysis. JAMA. 2014; 312(15):1552-64. DOI: 10.1001/jama.2014.6364. View

14.

Arda B, Yamazhan T, Sipahi O, Islekel S, Buke C, Ulusoy S . Meningitis due to methicillin-resistant Staphylococcus aureus (MRSA): review of 10 cases. Int J Antimicrob Agents. 2005; 25(5):414-8. DOI: 10.1016/j.ijantimicag.2004.12.005. View

15.

Chen K, Wu Y, Wang Q, Wang J, Li X, Zhao Z . The methodology and pharmacokinetics study of intraventricular administration of vancomycin in patients with intracranial infections after craniotomy. J Crit Care. 2014; 30(1):218.e1-5. DOI: 10.1016/j.jcrc.2014.09.020. View

16.

Reiter P, Doron M . Vancomycin cerebrospinal fluid concentrations after intravenous administration in premature infants. J Perinatol. 1996; 16(5):331-5. View

17.

Baxi S, Clemenzi-Allen A, Gahbauer A, Deck D, Imp B, Vittinghoff E . Vancomycin MIC Does Not Predict 90-Day Mortality, Readmission, or Recurrence in a Prospective Cohort of Adults with Staphylococcus aureus Bacteremia. Antimicrob Agents Chemother. 2016; 60(9):5276-84. PMC: 4997864. DOI: 10.1128/AAC.00658-16. View

18.

Simon T, Hall M, Riva-Cambrin J, Albert J, Jeffries H, LaFleur B . Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States. Clinical article. J Neurosurg Pediatr. 2009; 4(2):156-65. PMC: 2896258. DOI: 10.3171/2009.3.PEDS08215. View

19.

Van Hal S, Lodise T, Paterson D . The clinical significance of vancomycin minimum inhibitory concentration in Staphylococcus aureus infections: a systematic review and meta-analysis. Clin Infect Dis. 2012; 54(6):755-71. DOI: 10.1093/cid/cir935. View

20.

Klugman K, Friedland I, Bradley J . Bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with acute bacterial meningitis. Antimicrob Agents Chemother. 1995; 39(9):1988-92. PMC: 162869. DOI: 10.1128/AAC.39.9.1988. View