Knoll Bettina M, Hellmann Matt, Kotton Camille N
Department of Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Scand J Infect Dis. 2013 Feb;45(2):131-9. doi: 10.3109/00365548.2012.717711. Epub 2012 Sep 19.
Vancomycin-resistant Enterococcus faecium (VR E. faecium) is a rare cause of meningitis and is associated with substantial mortality. Limited therapeutic options are available for the treatment of VR E. faecium meningitis. The optimum therapy has not been established.
We retrospectively identified adult cases of meningitis due to VR E. faecium that occurred at the Massachusetts General Hospital from 1999 to 2011 and performed a literature search for published adult cases using Medline and Embase.
At our institution, 4 cases of meningitis due to VR E. faecium were identified. Three out of our 4 cases were successfully treated with linezolid in combination with rifampicin, or with daptomycin in combination with quinupristin-dalfopristin (QD), and 1 out of 4 with linezolid monotherapy. The literature search yielded 18 cases published to date. Published cases showed bacterial cure with linezolid, chloramphenicol or QD (intravenous (IV) and intrathecal (IT)) monotherapy, or linezolid in combination with ampicillin, gentamicin, rifampicin or chloramphenicol, or daptomycin in combination with gentamicin or QD.
Bacterial cure of meningitis due to VR E. faecium can be achieved with various antimicrobial drugs used as monotherapy or in combination. IT in addition to IV therapy should be considered dependent on the pharmacological properties of the drugs. We also reported the successful treatment of a case with a vancomycin-resistant, linezolid-intermediate isolate with QD and daptomycin. The paucity of cases with this clinical syndrome does not allow the identification of an optimal treatment regimen.
耐万古霉素屎肠球菌（VR屎肠球菌）是脑膜炎的罕见病因，且与高死亡率相关。治疗VR屎肠球菌脑膜炎的治疗选择有限。最佳治疗方案尚未确立。
我们回顾性确定了1999年至2011年在马萨诸塞州总医院发生的成人VR屎肠球菌脑膜炎病例，并使用Medline和Embase对已发表的成人病例进行文献检索。
在我们机构，确定了4例VR屎肠球菌脑膜炎病例。我们的4例病例中有3例成功接受了利奈唑胺联合利福平治疗，或达托霉素联合奎奴普丁-达福普汀（QD）治疗，4例中有1例接受了利奈唑胺单药治疗。文献检索得出迄今已发表的18例病例。已发表的病例显示，利奈唑胺、氯霉素或QD（静脉注射（IV）和鞘内注射（IT））单药治疗，或利奈唑胺联合氨苄西林、庆大霉素、利福平或氯霉素，或达托霉素联合庆大霉素或QD可实现细菌清除。
使用各种抗菌药物单药治疗或联合治疗可实现VR屎肠球菌脑膜炎的细菌清除。除静脉治疗外，应根据药物的药理学特性考虑鞘内治疗。我们还报告了1例对万古霉素耐药、对利奈唑胺中介的菌株使用QD和达托霉素成功治疗的病例。这种临床综合征的病例较少，无法确定最佳治疗方案。
