Evaluation of Intraventricular Teicoplanin for the Treatment of Neurosurgical Shunt Infections

Abstract

Seven patients with staphylococcal neurosurgical shunt infections were treated with intraventricular teicoplanin. Two infants received 5 mg/d, three patients received 20 mg/d, and two patients received 20 mg every other day. Six of these patients also received intravenous antibiotics. Three patients had infections caused by methicillin-susceptible Staphylococcus epidermidis, and one patient had an infection caused by methicillin-resistant S. epidermidis. Three patients were infected with Staphylococcus aureus (one with a methicillin-resistant strain and two with methicillin-susceptible strains). The mean duration of intraventricular therapy was 16 days. Sterilization of cerebrospinal fluid (CSF) was obtained after an average of 4.4 days. All patients were cured both clinically and microbiologically. No significant adverse effects were observed in any patients. Penetration of teicoplanin into the CSF after intravenous administration was poor. However, after intraventricular administration, high and prolonged peak and trough levels of teicoplanin were detected in the CSF. Bactericidal activity of the CSF was remarkable, exceeding the 1:8 dilution in the majority of the cases. The alternate-day schedule of intraventricular administration of teicoplanin was as effective as the once-daily regimen.

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

“…Intravenous and intraventricular quinupristin/dalfopristin has been used successfully to treat a patient with ventriculostomy-related meningitis caused by vancomycin-resistant Enterococcus faecium [132]. Teicoplanin, a glycopeptide antimicrobial agent not currently licensed in the United States, was also found to be successful after intraventricular administration in 7 patients with staphylococcal neurosurgical shunt infections [133]. Intraventricular daptomycin was successfully used in individual case reports in patients with CSF shunt and CSF drain infections caused by methicillin-resistant coagulase-negative staphylococci and resistant enterococci [134][135][136][137].…”

Epidemiology, Prevention and Management of Ventriculoperitoneal Shunt Infections in Children

“…In case of CoNS infections with teicoplanin-sensitive pathogens, both systemic administration and additional intrathecal administration are options [111,112]. Reports of the intrathecal administration of tobramycin, amikacin, colistin and amphotericin B have been published as well [34].…”

Meningitis due to methicillin-resistant Staphylococcus aureus (MRSA): Review of 10 cases

“…An additional strategy is combination therapy such as vancomycin + rifampicin which has excellent activity against S. aureus with low MICs and excellent CNS penetration [12]. There are fewer papers describing the use of teicoplanin in MRSA meningitis than those describing vancomycin use [4][5][6]. Teicoplanin has favourable pharmacokinetics, including an extremely long half-life.…”

“…Methicillin-resistant S. aureus (MRSA) has emerged as an important cause of hospital-acquired central nervous system (CNS) infections [1][2][3]. Although the usual therapeutic choice is vancomycin, there have been a few cases reported that have been treated with intrathecal teicoplanin [4][5][6].…”