1 - InfectiousDiseasesUnit, Hospital de Dona Estefânia EPE. Lisbon. Portugal
2 - PediatricNeurosurgeryUnit, Hospital de Dona Estefânia EPE. Lisbon. Portugal
- 36th Annual Meeting of the European Society for Paediatric Infectious Diseases, May 28 – June 2, Malmö, Sweden
Introduction: Treatment of post-neurosurgical meningitis, ventriculitis or central nervoussystem (CNS) shunt infections is challenging and associated
with a high morbimortality rate. The emergence of methicillin-resistant strains of Staphylococcus (MRS)difficults even more treatment options.
Case report: We report four pediatric neurosurgical patients with meningitis and VPS infection due to MRS treated with intraventricular vancomycin.
Case 1 - A fifteen-months-old boy submitted to ventricular-peritoneal shunt (VPS) replacement the month before, with Staphylococcus aureusmethicilin-resistant isolated oncerebrospinal fluid (CSF). After twelve days of intravenous vancomycin and rifampin the CSF cultures remained positive;
Case 2 - A five-month-old girl, with Staphylococcus epidermidismethicilin-resistant (MRSE) VPS infection. On the tenth day of vancomycin and rifampin the fever persisted and the inflammatory parameters increased;
Case 3 - A five-month-old boy submitted do VPS placement 3 months before with CSFStaphylococcus epidermidis (DNA16S) infection. Alterations in CSF biochemical exam persisted after vancomycin for 10 days;
Case 4 - A six-month-old boy submitted to multiple VPS and shunt revisions, with a MRSE isolated on CSF. He was treated with vancomycin and rifampin with no improvement and CSF cultures remained positive. Intraventricular vancomycin (5-10mg/day) was associated in all patients.
The duration of intraventricular treatment after clinical and bacteriologic improvement was variable (median of 11 days). Successful clinical outcome was achieved in all patients, with no side effects or relapses.
Conclusion: Although there areonly a few pediatric case reports in theliterature, intraventricular vancomycin seems to be an effective, well tolerated treatment and should be considered when conventional therapy fails. Further studies are needed to determine the appropriate vancomycin dosage and duration of therapy in these patients.
Key-words: intraventricular vancomycin, shunt infections