Central nervous system infections due to vancomycin-resistant enterococci: case series and review of the literature

Jeffrey S Wang; Katie Muzevich; Michael B Edmond; Gonzalo Bearman; Michael P Stevens

doi:10.1016/j.ijid.2014.01.009

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Central nervous system infections due to vancomycin-resistant enterococci: case series and review of the literature

Journal article

Open access

Peer reviewed

Central nervous system infections due to vancomycin-resistant enterococci: case series and review of the literature

Jeffrey S Wang, Katie Muzevich, Michael B Edmond, Gonzalo Bearman and Michael P Stevens

International Journal of Infectious Diseases, Vol.25, pp.26-31

08/2014

DOI: 10.1016/j.ijid.2014.01.009

PMID: 24846601

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Abstract

To evaluate reported cases of central nervous system (CNS) infections due to vancomycin-resistant enterococci (VRE) and describe the data necessary to better understand clinical characteristics of this rare disease process. We report two cases of VRE CNS infection and review 36 cases reported in the literature. Eighty-two percent (31/38) of cases were due to Enterococcus faecium. The median length of stay prior to diagnosis was 14 days (interquartile range 9–33). Fifty-eight percent (22/38) of cases had significant underlying non-malignant CNS disease processes and 63% (24/38) had CNS devices in situ. Forty percent (15/38) of patients had other positive culture sites. Ninety-two percent (35/38) of patients experienced microbiological cure and 74% (28/38) experienced clinical and microbiological cure following a variety of antimicrobial therapies. Seventy-four percent (14/19) of patients who experienced clinical/microbiological cure with CNS devices had them either removed or replaced. Eighteen percent (7/38) died from VRE CNS infections. VRE CNS infections are uncommon nosocomial infections that most commonly affect patients with underlying CNS disease processes. The vast majority of cases are due to E. faecium, and many cases involve multiple positive culture sites. Optimal antimicrobial therapy remains undefined, but should be coupled with removal or replacement of indwelling CNS devices.

Meningitis

Ventriculitis

Vancomycin-resistant enterococci

Details

Title: Subtitle: Central nervous system infections due to vancomycin-resistant enterococci: case series and review of the literature
Creators: Jeffrey S Wang - Department of Internal Medicine, Virginia Commonwealth University Medical Center, Box 980509, Richmond, VA 23298-0019, USA
Katie Muzevich - Department of Pharmacy Services, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
Michael B Edmond - Division of Infectious Diseases, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
Gonzalo Bearman - Division of Infectious Diseases, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
Michael P Stevens - Division of Infectious Diseases, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
Resource Type: Journal article
Publication Details: International Journal of Infectious Diseases, Vol.25, pp.26-31
DOI: 10.1016/j.ijid.2014.01.009
PMID: 24846601
NLM abbreviation: Int J Infect Dis
ISSN: 1201-9712
eISSN: 1878-3511
Publisher: Elsevier Ltd
Language: English
Date published: 08/2014
Academic Unit: Internal Medicine
Record Identifier: 9983905523802771

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