Barnes Brian J, Wiederhold Nathan P, Micek Scott T, Polish Louis B, Ritchie David J
College of Pharmacy, University of Kansas Medical Center, Kansas City, Kansas, USA.
Pharmacotherapy. 2003 Apr;23(4):537-42. doi: 10.1592/phco.23.4.537.32126.
A 55-year-old woman was found unresponsive and subsequently was diagnosed with a subarachnoid hemorrhage secondary to a right posterior communicating artery aneurysm. The development of hydrocephalus and decreased mental status necessitated placement of an intraventricular catheter; 18 days later she was diagnosed with Enterobacter cloacae ventriculitis. After treatment was begun with intravenous cefepime 2 g every 8 hours and intraventricular gentamicin 5 mg every 24 hours, the catheter was replaced. Cerebrospinal fluid (CSF) and plasma cefepime concentrations and a CSF trough gentamicin concentration were obtained. Intraventricular gentamicin was administered for 6 days and cefepime for 21 days; both clinical and microbiologic resolution of the ventriculitis occurred. The literature reports limited clinical experience with cefepime for the treatment of central nervous system infections in humans. This case report provides clinical evidence to support administration of intravenous cefepime in critically ill adult patients with Enterobacter ventriculitis. Because CSF is easily obtained from patients with intraventricular catheters, strong consideration should be given to monitoring CSF cefepime concentrations in concert with the minimum inhibitory concentration of the offending pathogen to help assure the efficacy of this approach to therapy.
一名55岁女性被发现无反应，随后被诊断为继发于右后交通动脉瘤的蛛网膜下腔出血。脑积水的发展和精神状态下降使得需要放置脑室内导管；18天后，她被诊断为阴沟肠杆菌脑室炎。在开始每8小时静脉注射2克头孢吡肟和每24小时脑室内注射5毫克庆大霉素治疗后，更换了导管。获得了脑脊液（CSF）和血浆中的头孢吡肟浓度以及脑脊液中庆大霉素的谷浓度。脑室内注射庆大霉素6天，头孢吡肟21天；脑室炎的临床和微生物学症状均得到缓解。文献报道头孢吡肟治疗人类中枢神经系统感染的临床经验有限。本病例报告提供了临床证据，支持在患有阴沟肠杆菌脑室炎的重症成年患者中静脉注射头孢吡肟。由于通过脑室内导管的患者很容易获取脑脊液，因此应充分考虑监测脑脊液中的头孢吡肟浓度，并结合致病病原体的最低抑菌浓度，以确保这种治疗方法的有效性。
