Treatment of Intracranial Infection Caused by Methicillin-Resistant Staphylococcus epidermidis with Linezolid Following Poor Outcome of Vancomycin Therapy: A Case Report and Literature Review

Figures & data

Figure 1 Treatment regimens and CSF cell counts.

Abbreviations: TZP, piperacillin-tazobactam; VAN, vancomycin; CRO, ceftriaxone; MEM, meropenem; LZD, linezolid (discontinued from May 10 to May 11); CAZ, ceftazidime.

Figure 2 Treatment regimens and concentration of protein and sugar in CSF.

Abbreviations: TZP, piperacillin-tazobactam; VAN, vancomycin; CRO, ceftriaxone; MEM, meropenem; LZD, linezolid (discontinued from May 10 to May 11); CAZ, ceftazidime.

Table 1 Clinical Characteristics of 23 Patients with Intracranial Infection Treated with Linezolid

Patient No. (Refere-nce)	Age	Gender	CSF Leukocytes;	Previous Treatment	Pathogen	MIC (mg/L) Vancomycin/Linezolid	Treatment and Duration	Outcomes
1[^Citation17]	62 years	Male	NA	Linezolid	MRSA	1/4	Linezolid +daptomycin+ rifampicin 3 weeks	Cured
2[^Citation24]	77 years	Male	NA	Vancomycin, ampicillin/sulbactam	VISA	4/NA	Linezolid (11d-27d), Moxifloxacin (28d-51d)	Cured
3[^Citation25]	43 years	Female	NA	Vancomycin	MRCoNS	4/1.5	Linezolid + rifampicin 12 weeks	Cured
4[^Citation13]	80 years	Male	>1×10^9/L	Ceftizoxime, vancomycin	MRSA	2/NA	Linezolid (600 mg×2), 28 days; piperacillin/ tazobactam (4.5 g ×3) after 5 days of linezolid, lasting 3 weeks	Microbiologically cured, but died 3 months later due to gastric bleeding
5[^Citation13]	72 years	Female	>1×10^9/L	Ceftizoxime, ceftazidime, vancomycin	MRSA	2/NA	Linezolid (600 mg×2), 21 days	Cured
6[^Citation13]	36 years	Male	0.25×10^9/L	Ceftizoxime, meropenem	MRSA	2/NA	Linezolid (600 mg×2), 21 days	Microbiologically cured, but died due to intracranial haematoma 2 months later
7[^Citation13]	69 years	Male	>1×10^9/L	Ceftizoxime, vancomycin	MRSA	2/NA	Linezolid (600 mg×2), 10 days	Microbiological failure; died despite addition of daptomycin on day 6
8[^Citation13]	65 years	Female	0.3×10^9/L	Ceftizoxime, imipenem, vancomycin	MRSA	2/NA	Linezolid (600 mg×2), 21 days	Microbiologically cured, but died 1 month later due to Pseudomonas aeruginosa meningitis
9[^Citation13]	34 years	Female	0.7×10^9/L	Ceftizoxime, meropenem	MRCoNS	2/NA	Linezolid (600 mg×2), 21 days	Microbiologically cured; survived
10[^Citation13]	28 years	Male	0.35×10^9/L	Ceftizoxime	MRCoNS	2/NA	Linezolid (600 mg×2), 21 days	Microbiologically cured; survived
11[^Citation26]	34 years	Male	16.32×10^9/L	Cefatriaxone, vancomycin, Levofloxacin	MRSA	1.5/0.25	Linezolid+ Levofloxacin, 59 days	Cured
12[^Citation27]	22 days	Female	0.18×10^9/L	Ampicillin, cefotaxime, vancomycin	MRCoNS	2/1	Linezolid, 40 days	Cured
13[^Citation27]	11 months	Female	0.11×10^9/L	Vancomycin	MRCoNS	2/1	Linezolid, 57 days	Cured
14[^Citation28]	51 years	Female	0.23×10^9/L	Vancomycin, cefotaxime	MRCoNS	2/1	Linezolid (600 mg×2), 14 days	Cured
15[^Citation28]	26 years	Male	0.156×10^9/L	Vancomycin, cefotaxime	MRCoNS	2/1	Linezolid (600 mg×2), 14 day, ceftazidime (2 g×3), 10 days	Cured
16[^Citation28]	23 years	Male	0.36×10^9/L	Vancomycin, cefotaxime	MRSA	2/1	Linezolid (600 mg×2), 14 days	Cured
17[^Citation28]	38 years	Female	0.29×10^9/L	Vancomycin, cefotaxime	MRSA	2/1	Linezolid (600 mg×2), 14 days, colistin (3 MUI×3), 15 days	Cured
18[^Citation28]	47 years	Male	0.41×10^9/L	Vancomycin, cefotaxime	MRSA	2/1	Linezolid (600 mg×2), 14 days	Cured
19[^Citation28]	58 years	Female	0.189×10^9/L	Vancomycin, cefotaxime	MRCoNS	2/1	Linezolid (600 mg×2), 14 days	Cured
20[^Citation28]	49 years	Female	0.258×10^9/L	Vancomycin, cefotaxime	MRSA	2/1	Linezolid (600 mg×2), 14 days	Cured
21[^Citation28]	67 years	Male	NA	Vancomycin, cefotaxime	MRSA	2/1	Linezolid (600 mg×2), 28 days	Cured
22[^Citation28]	71 years	Male	NA	Vancomycin, cefotaxime	MRSA	2/1	Linezolid (600 mg×2), 42 days	Cured
23[^Citation28]	58 years	Female	8.1×10^9/L	Vancomycin, cefotaxime	MRSA	2/1	Linezolid (600 mg×2), 14 days	Cured

Kelesidis T, Humphries R, Ward K, et al. Combination therapy with daptomycin, linezolid, and rifampin as treatment option for MRSA meningitis and bacteremia. Diagn Microbiol Infect Dis. 2011;71(3):286–290. doi:10.1016/j.diagmicrobio.2011.07.00121855248

 PubMed Web of Science ®Google Scholar

Kino H, Suzuki H, Yamaguchi T, et al. Central nervous system infection caused by vancomycin-intermediate Staphylococcus aureus (SCCmec type IV, ST8). J Infect Chemother. 2014;20(10):643–646. doi:10.1016/j.jiac.2014.06.00825012468

 PubMed Web of Science ®Google Scholar

Kruse AJ, Peerdeman SM, Bet PM, et al. Successful treatment with linezolid and rifampicin of meningitis due to methicillin-resistant Staphylococcus epidermidis refractory to vancomycin treatment. Eur J Clin Microbiol Infect Dis. 2006;25(2):135–137. doi:10.1007/s10096-006-0097-z16474940

 PubMed Web of Science ®Google Scholar

Sipahi OR, Bardak S, Turhan T, et al. Linezolid in the treatment of methicillin-resistant staphylococcal post-neurosurgical meningitis: a series of 17 cases. Scand J Infect Dis. 2011;43(10):757–764. doi:10.3109/00365548.2011.58517721671825

 PubMed Web of Science ®Google Scholar

Fernández-Ruiz M, Cervera C, Pitart C, et al. Community-acquired methicillin-resistant Staphylococcus aureus meningitis complicated by cerebral infarction. Role of antibiotic combination of linezolid plus levofloxacin. Intern Med. 2010;49(18):1971–1974. doi:10.2169/internalmedicine.49.394220847500

 PubMed Web of Science ®Google Scholar

Ochi F, Tauchi H, Nagai K, et al. Therapeutic effect of linezolid in children with health care-associated meningitis or ventriculitis. Clin Pediatr (Phila). 2018;57(14):1672–1676. doi:10.1177/000992281880339930261749

 PubMed Web of Science ®Google Scholar

Rebai L, Fitouhi N, Daghmouri MA, et al. Linezolid for the treatment of postneurosurgical infection caused by methicillin-resistant Staphylococcus. Surg Neurol Int. 2019;10:215. doi:10.25259/SNI_455_201931819809

 PubMedGoogle Scholar