BACKGROUND: A 1-month-old premature infant developed persistent shunt-related methicillin-resistant Staphylococcus aureus ventriculitis that was not responsive to parenteral therapy with vancomycin plus gentamicin (or rifampin). METHODS: The infant was treated by intraventricular administration of vancomycin (5 days: 10 mg/day). In addition to standard testing of the cerebrospinal fluid (CSF), tumor necrosis factor alpha, interleukin-8 and interleukin-6 were serially measured. RESULTS: Sterilization of the CSF was followed by a decline in the number of WBC and proinflammatory cytokines in the CSF. CONCLUSION: Intraventricular administration of antibiotics may be considered if ventriculitis is refractory to systemic antimicrobial therapy. Serial measurements of inflammatory cytokines in the CSF may provide an additional diagnostic tool to monitor the outcome of therapy. Copyright 2005 S. Karger AG, Basel.
BACKGROUND: A 1-month-old premature infant developed persistent shunt-related methicillin-resistant Staphylococcus aureusventriculitis that was not responsive to parenteral therapy with vancomycin plus gentamicin (or rifampin). METHODS: The infant was treated by intraventricular administration of vancomycin (5 days: 10 mg/day). In addition to standard testing of the cerebrospinal fluid (CSF), tumornecrosis factor alpha, interleukin-8 and interleukin-6 were serially measured. RESULTS: Sterilization of the CSF was followed by a decline in the number of WBC and proinflammatory cytokines in the CSF. CONCLUSION: Intraventricular administration of antibiotics may be considered if ventriculitis is refractory to systemic antimicrobial therapy. Serial measurements of inflammatory cytokines in the CSF may provide an additional diagnostic tool to monitor the outcome of therapy. Copyright 2005 S. Karger AG, Basel.