A case of ventricular drainage infection with a rare pathogen in cerebrospinal fluid: vancomycin-resistant Enterococcus faecium

Abstract number: 1134_04_13

Baysallar M., Izci Y., Kilic A., Avci I.Y., Senses Z., Doganci L.

Objectives:  

To describe a patient, 7-month-old child with ventriculoperitoneal shunts for hydrocephalus who developed ventriculitis caused by VREF.

Methods:  

Two ventriculoperitoneal shunts were inserted just after birth and on the 2nd month of age. On the 6th month, both of them were removed because of dysfunction and external drainage was inserted. Then, he developed fever and lumbar puncture revealed high leucocyte count and protein concentration. CSF cultures yielded E. faecium which was resistant to ampicillin, erythromycin, gentamicin, penicillin G, vancomycin, teicoplanin and susceptible to chloramphenicol, ciprofloxacin, streptomicin, levofloxacin and rifampin by disk diffusion method. On the antimicrobial susceptibility tests, multidrug antibiotic therapy was changed from vancomycin and ceftazidime to chloramphenicol, rifampin and meropenem, and also rifampin–clindamycin-impregnated bactericeal shunt (Codman-USA) was inserted.

Results:  

He become a febrile and CSF cultures was sterile after 15 days of yielding E. faecium.

Conclusion:  

Implanting rifampin–clindamycin-impregnated bactericeal shunt and timely use of appropriate antibiotics for 10 days according to antimicrobial susceptibility testing seemed to be important in the resolution of VRE infections, especially in countries where linezolid and quinupristin–dalfopristin are not in use yet.