A 67-year-old man who had twice previously undergone operations for a tuberculum sellae meningioma was admitted to hospital
for further treatment. After the third surgical intervention, the patient developed persistent low-grade fever and impaired
consciousness. Computed tomography, 1 week after surgery, showed postsurgical hydrocephalus. Cerebrospinal fluid (CSF) studies
revealed high intracranial pressure (above 30 cm H
2O), and increased cell count (1232/3). One week after the ventricular drainage, coagulase-negative
Staphylococcus epidermidis was recovered from his CSF, and antimicrobial susceptibility results indicated that the organism was methicillin-resistant.
After 14 days of intravenous vancomycin (VCM) administration failed, linezolid (LZD) was initialized intravenously, resulting
in a resolution of the meningitis. After a ventriculoperitoneal shunt procedure was performed, LZD was continued orally, which
resulted in a cure. CSF penetration by VCM is reported to be poor, i.e., approximately 10% of serum concentration, which may
explain its lack of efficacy. In this case, the penetration of LZD into the CSF was 58.9% of the peak value and 133% of the
trough value of serum concentrations. LZD must be considered one of the first-line treatments against surgical-site infection
in neurosurgery caused by methicillin-resistant
Staphylococci.
Key words Surgical site infection (SSI) - Meningitis - Methicillin-resistant Staphylococcus epidermidis (MRSE) - Linezolid (LZD) - Neurosurgery