Citrobacter Ventriculitis in a Neonate Responsive to Trimethoprim-sulfamethoxazole

There are increasing reports of citrobacter central nervous system infections in neonates. These organisms cause brain abcesses in a high percentage of pa tients. They may be resistant to commonly used antibiotics. We report a term male infant with underlying meningo-myelocoele and hydrocephalus in whom Citrobacter diversus meningitis and ventriculitis developed. Initial antibiotic ther apy including intraventricular amikacin failed to sterilize the ventricles or alter a deteriorating clinical course. Adding intravenous trimethoprim-sulfamethox azole to the therapeutic regimen resulted in reversal of a progressively worsening condition and eventual recovery. Trimethoprim-sulfamethoxazole should be con sidered as a potentially useful alternative antibiotic for susceptible central ner vous system infections.