Development of VRE meningitis due to haematogenous spread while on high-dose daptomycin therapy

Srivani Sanikommu; Katherine Lusardi; Lyle Burdine; Ryan K Dare

doi:10.1093/jacamr/dlad118

Development of VRE meningitis due to haematogenous spread while on high-dose daptomycin therapy

JAC Antimicrob Resist. 2023 Nov 17;5(6):dlad118. doi: 10.1093/jacamr/dlad118. eCollection 2023 Dec.

Authors

Srivani Sanikommu¹, Katherine Lusardi², Lyle Burdine³, Ryan K Dare¹

Affiliations

¹ Department of Internal Medicine, Division of Infectious Diseases, University of Arkansas for Medical Sciences, 4301 W Markham Slot #639, Little Rock, AR, USA72205-7101.
² Baptist Health Medical Center, Little Rock, AR, USA.
³ Department of Surgery, University of Arkansas for Medical Sciences, 4301 W Markham Slot #639, Little Rock, AR, USA72205-7101.

Abstract

Introduction: Vancomycin-resistant Enterococcus faecium (VRE) meningitis accounts for only 0.3%-4.0% of bacterial meningitis cases and typically occurs following neurosurgical intervention. We describe a rare case of a patient without neurological devices in situ or a recent neurological procedure who developed VRE meningitis via haematogenous spread. Optimal treatment for VRE meningitis is unknown.

Case presentation: A 67-year-old male with end-stage liver failure underwent liver transplantation complicated by VRE bacteraemia and subsequently developed VRE meningitis while on high-dose daptomycin therapy (12 mg/kg/day). Due to clinical and microbiological failure with daptomycin, he was switched to linezolid and symptoms resolved rapidly. He completed 2 weeks of linezolid, fully recovered, and continued to do well without complications at the 5 month follow-up.

Conclusions: This case highlights the severity of VRE infections in solid organ transplant recipients and raises concerns about daptomycin penetration into the CNS. Linezolid could be considered the preferred treatment for VRE CNS infections rather than high-dose daptomycin.