Experience with enterococcal meningitis/ventriculitis in children

Abstract

BackgroundEnterococcal infections are increasingly common in hospitalized patients. Enterococcal meningitis/ventriculitis (EMV) is an extremely rare condition of enterococcal infections, occurring particularly in children. This study investigated the clinical and microbiological characteristics, predisposing factors, and prognosis in pediatric patients with EMV.MethodsPediatric patients (<18 years) diagnosed with EMV were retrospectively evaluated over 10 years.ResultsThe study included a total of 25 isolates from 24 patients, median age 23 months (range: 1–136 months). The most common symptoms included vomiting, fever, and headache, with hydrocephalus shunt and preterm birth being the two most common conditions. Commonly associated infections, with central nervous system (CNS) devices as a predisposing factor, were due to external ventricular drainage and ventriculoperitoneal shunts. Two patients with spontaneous meningitis were preterm infant. Of the isolates, 44% were Enterococcus faecalis, 44% E. faecium, and 12% E. gallinarum. Five (20%) isolates were vancomycin resistant. Twelve patients were resistant to anti‐enterococcal antibiotics, including ampicillin, ciprofloxacin, imipenem, teicoplanin, gentamicin, and linezolid (40%, 20%, 8%, 8%, 4%, and 4%, respectively). Enterococcus faecium was more resistant to ampicillin, ciprofloxacin, teicoplanin, and vancomycin than E. faecalis. The median treatment duration was 17 days (interquartile range: 14–26 days).The mortality rate was 8.3% (2/24; both associated with vancomycin resistance).ConclusionsNeurosurgical conditions are the most common predisposing factors for EMV. Preterm birth is an important predisposing factor in children. Because EMV is nonspecific in clinical findings, it should be considered when there is an underlying CNS disorder and empirical treatment should begin in this direction.

Challenges in Diagnosis and Treatment of Neonatal Ventriculitis: A Case Report and Systematic Review of Difficult-to-Treat Central Nervous System Infection Resistant to Conventional Therapy

“…60 Moreover, the pathogen distribution has shifted from GBS to MDR GNBs, 3,6,9,16,17,20,24,[28][29][30] Enterobacteriaceae. 31,32,35,38 GNB pathogens, in particular E. coli, Klebsiella, and Pseudomonas species, are detected in 20 to 25% of early-onset bacteremia and 14% of infant meningitis worldwide. 61 Acinetobacter 8), left against advice (6), survivors (22), and neurologic sequelae (8) Bentlin et al 45 Epidemiological study…”

“…29,30,33,34 Çay et al reported their experience with enterococcal meningitis/ventriculitis in 24 children, including neonates (median age, 23 months), finding that EVD and VPS insertion were the major predisposing factors. 38 CNS infections were postoperative (28%), posttraumatic (8%), and spontaneous (8%).…”

“…Another search on Google Scholar was performed to identify articles published in non-PubMed indexed journals. Seven publications were found, so we finally reviewed 37 texts (20 case reports, 6 case series, 6,7, and 11 original articles 2,3,9,[38][39][40][41][42][43][44][45] [5 retrospective and 3 epidemiological surveillance studies, 1 prospective observational study, 1 pilot population pharmacokinetic modeling study, and 1 research article]).…”