Vancomycin-resistant enterococci (VRE) are a rare cause of
meningitis, occurring primarily in patients who have undergone
neurosurgical procedures. We describe the first reported case of VRE
meningitis successfully treated with
linezolid. A 56-y-old female with
subarachnoid hemorrhage underwent
ventriculostomy and embolization of
cerebral aneurysms. Her postoperative course was complicated by multiple
infections needing repeated
antibiotic courses, culminating in the development of VRE
meningitis. She was treated with 600 mg of i.v.
linezolid (MIC < 0.75 microg/ml) every 12 h for 6 weeks. After the fourth dose, peak and trough
linezolid concentrations were 11.45 and 0.14 microg/ml in serum and 3.19 and 2.39 microg/ml in cerebral spinal fluid (CSF). On Day 19 of
linezolid therapy, serum and CSF trough concentrations were 1.53 and 2.98 microg/ml, respectively.
Linezolid achieved sufficient CSF concentrations to bring about clinical and bacteriological cure. We conclude that i.v.
linezolid may be a useful option for treating VRE
meningitis. We also present findings of a literature review, which identified 11 cases of VRE
meningitis treated with other pharmacologic agents with mixed success.