Abstract |
A 70-year-old Japanese man developed fever, headache, and lumbago, presumably due to an epidural abscess caused by methicillin-resistant Staphylococcus aureus (MRSA) in the L5-S2 region. On the night of admission to our hospital, he showed disorientation to places and abnormal eating behavior, indicating a complication of MRSA meningitis. Cerebrospinal fluid (CSF) examination confirmed this diagnosis. Although he was treated with venous infusion of vancomycin and meropenem, the CSF culture remained positive for MRSA even a week after the treatment, and Gram-positive cocci were also seen in the CSF. An intrathecal injection of vancomycin (10mg/day) was subsequently added, which resulted in absence of the organism on Gram-stained CSF smear and CSF culture a week later. His condition improved without any adverse effects. Vancomycin cannot freely penetrate the blood-brain barrier (BBB); therefore, when administered intravenously, its concentration in the CSF is insufficient. Therefore, intrathecal injection of vancomycin is necessary to achieve the desired bacteriocidal level in the CSF. Thus, intrathecal administration of vancomycin seems a very effective and safe treatment for MRSA meningitis.
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Authors | Kazuya Goto, Takekazu Ohi, Akiko Namba, Norihito Uemura, Hiroshi Kitaguchi |
Journal | Brain and nerve = Shinkei kenkyu no shinpo
(Brain Nerve)
Vol. 63
Issue 4
Pg. 417-21
(Apr 2011)
ISSN: 1881-6096 [Print] Japan |
PMID | 21441646
(Publication Type: Case Reports, English Abstract, Journal Article)
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Chemical References |
- Anti-Bacterial Agents
- Vancomycin
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Topics |
- Aged
- Anti-Bacterial Agents
(administration & dosage)
- Epidural Abscess
(microbiology)
- Humans
- Injections, Spinal
- Male
- Meningitis, Bacterial
(drug therapy, microbiology)
- Methicillin Resistance
- Staphylococcal Infections
- Staphylococcus aureus
- Treatment Outcome
- Vancomycin
(administration & dosage)
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