Successful treatment of vancomycin-resistant enterococcus ventriculitis in a child.

UNLABELLED: Enterococci are an uncommon cause of CNS infection. A 20 month-old boy, diagnosed with hydrocephalus with ventriculoperitoneal shunt and history of lengthy hospitalization and use of wide spectrum antibiotics, was admitted to the pediatric intensive care unit diagnosed with ventriculitis. On the 14th day of empirical antibiotic therapy (vancomycin and meropenem) the child presented fever while the CSF sample culture evidenced vancomycin-resistant Enterococcus faecium. The patient received intravenous linezolid achieving cerebrospinal fluid sterilization. CONCLUSION: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus ventriculoperitoneal shunt infection.

Successful treatment of vancomycin-resistant enterococcus ventriculitis in a child

Enterococci are an uncommon cause of CNS infection. A 20 month-old boy, diagnosed with hydrocephalus with ventriculoperitoneal shunt and history of lengthy hospitalization and use of wide spectrum antibiotics, was admitted to the pediatric intensive care unit diagnosed with ventriculitis. On the 14th day of empirical antibiotic therapy (vancomycin and meropenem) the child presented fever while the CSF sample culture evidenced vancomycin-resistant Enterococcus faecium. The patient received intravenous linezolid achieving cerebrospinal fluid sterilization. Conclusion: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus ventriculoperitoneal shunt infection.

Avaliaçäo da qualidade dos discos com antimicrobianos para testes de disco-difusäo disponíveis comercialmente no Brasil / Evaluation of the quality of the antimicrobial agents disks used in disk-diffusion tests comercially available in Brazil

Introduçäo: O teste de suscetibilidade a antimicrobianos representa um dos testes de maior importância clínica realizados pelo laboratório de microbiologia. Devido ao grande número de antimicrobianos e à complexidade dos mecanismos de resistência desenvolvidos pelas bactérias, fica muito difícil hoje a detecçäo de problemas nos testes de suscetibilidade pela simples avaliaçäo dos resultados obtidos. Sendo assim, é extremamente importante que haja uma avaliaçäo constante da qualidade destes testes. Objetivo: O objetivo do presente estudo foi avaliar a qualidade dos discos de antimicrobianos comercializados no Brasil. Material e métodos: Foram avaliados discos de 18 antimicrobianos obtidos de cinco diferentes fontes comerciais, os quais foram testados frente a quatro cepas bacterianas oriundas da ATCC, pelo método de difusäo em ágar, seguindo as recomendações do National Committee for Clinical Laboratory Standards (NCCLS). Cada teste foi repetido 20 vezes. Resultados: Nenhuma das marcas apresentou desempenho satisfatório para o uso na rotina de um laboratório de microbiologia. O melhor desempenho foi apresentado pela marca Cecon, com 89,6 por cento de concordância. A marca Sensifar apresentou taxa de concordância geral semelhante (90,8%). A marca com o pior desempenho foi a Pimenta Abreu, com apenas 58,6% de concordância. Conclusäo: Os resultados do presente estudo indicam que os discos de antimicrobianos comercializados no Brasil são de baixa qualidade, possivelmente refletindo a falta de controle de qualidade na produçäo e/ou estocagem dos produtos antes da sua distribuiçäo. Esses dados chamam a atençäo para a necessidade de implantaçäo de sistemas efetivos de fiscalizaçäo da comercializaçäo desses produtos e de programas criteriosos de controle de qualidade por parte dos laboratórios que os utilizam

Enterococcus faecalis resistant to vancomycin and teicoplanin (VanA Phenotype) isolated from a bone marrow transplanted patient in Brazil

We report for the first time in Brazil, patient from whom an Enterococcus faecalis VanA phenotype was isolated. Glycopeptide resistance is not commonly observed in Enterococcus faecalis, so this finding is of great concern since this species is responsible for 90 percent of enterococcal infections in Brazil. The isole was recovered from a surveillance rectal swab culture from a patient with acute lymphocytic (ALL). Identification to the species level was performed by conventional biomechanical tests and vitek GPI cards. Antimicrobial susceptibility testing was evaluated by use of broth microdilution and Etest (AB BIODISK, Solna, Sweden) methods. The isolate was identified as E. faecalis and was considered resistant to both vancomycin(MIC,>256µg/mL) and teicoplanin (MIC, 256 µg/mL). The isolate also showed high level resistance to gentamicin and streptomycin (MICs,>1024µg/mL), but was considered susceptible to ampicillin (MIC, 4µg/mL). Although the frequency of enterococcal infections is very low in most Latin American countries, the finding of glycopeptide (VanA) resistance in E. faecalis increases concern about apreading antimicrobial resistance in this region.