Effect of linezolid against postneurosurgical meningitis caused by methicillin-resistant Staphylococcus epidermidis: case report

J Infect Chemother. 2008 Apr;14(2):147-50. doi: 10.1007/s10156-007-0582-z. Epub 2008 Apr 30.

Abstract

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.

Publication types

  • Case Reports

MeSH terms

  • Acetamides / administration & dosage
  • Acetamides / therapeutic use*
  • Aged
  • Anti-Infective Agents / administration & dosage
  • Anti-Infective Agents / therapeutic use*
  • Humans
  • Linezolid
  • Male
  • Meningeal Neoplasms / surgery
  • Meningioma / surgery
  • Meningitis, Bacterial / drug therapy*
  • Meningitis, Bacterial / microbiology
  • Methicillin Resistance*
  • Neurosurgical Procedures / adverse effects*
  • Oxazolidinones / administration & dosage
  • Oxazolidinones / therapeutic use*
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / microbiology
  • Staphylococcus epidermidis / drug effects*
  • Treatment Outcome

Substances

  • Acetamides
  • Anti-Infective Agents
  • Oxazolidinones
  • Linezolid