Intravenous and Intraventricular Daptomycin Plus Intravenous Linezolid Treatment of an Infant with Vancomycin-Resistant Enterococci-Induced Ventriculoperitoneal Shunt Infection

Background The rate of ventriculoperitoneal (VP) shuntinfection is reported between 3% and 20%. Vancomycin-resistant enterococci (VRE) are increasingly prevalent nosocomial pathogens worldwide, and they rarely cause infections to the central nervous system. Daptomycinis a cyclic lipopeptideeffective antibiotic because of its rapid bactericidal effect. It is a life-saving treatment option for meningitis, bacteremia, sepsis, endocarditis, and urinary systeminfections caused by VRE. Case Description Here, we present a 2.5-month-old infant boy with a ventriculoperitoneal shuntinfection caused by vancomycin-resistant Enterococcusfaecium . This is the first report of a pediatric VP shuntinfection caused by VRE and treated with a combination of intravenous (IV) linezolidIV and intraventricular (IVT) daptomycin. Conclusion The patient was admitted to the medical center with umbilical discharge, and shuntrevision was applied with the thought of shuntdysfunction. Intermittent umbilical cerebrospinal fluid (CSF) leakage continued, and the patient experienced a fever 2 weeks after the operation. VRE growth in his CSF culture was treated by meropenemand linezolid. Upon continuation of the growth afterwards, the patient was referred to our hospital and underwent extraventricular drainage, and IV linezolid, IV daptomycin(8 mg/kg per day), and IVT daptomycin(2.5 mg/kg per day) was scheduled as treatment. On the fifth day of treatment, there was no growth in the culture, and no side effects were observed during the treatment. A VP shuntwas placed in the patient for the 15 days of IV daptomycinplus IVT treatment, and 36 days of linezolid. No infection was observed in the 8-month follow-up period.