Intraventricular plus Intravenous Tigecycline for the Treatment of Daptomycin Nonsusceptible Vancomycin-Resistant Enterococci in an Infant with Ventriculoperitoneal Shunt Infection

ABSTRACT VP shunt infection, which is one of the most important complications of ventriculoperitoneal (VP) shunt is observed at a rate of 4-17%. Staphylococcus epidermidis is the most common causative agent. Vancomycin-resistant Enterococcus (VRE) is an increasingly common nosocomial pathogen that rarely causes central nervous system (CNS) infections globally. Current treatment options that have shown appreciable activity against various VRE infections include daptomycin, linezolid, inquinupristin/dalfopristin, and tigecycline. Daptomycin has a peculiar mode of action and a potent bactericidal activity, making it a useful addition to the clinician’s antibiotic collection. Global surveillance data indicate less than 1.0% rates of daptomycin resistance in enterococci. Tigecycline is a life-saving option in the treatment of resistant nosocomial infections but it has not yet been approved for use and there is not enough data in terms of dose and side effects associated with its use in children. Here, we describe the first case of the successful intraventricular plus intravenous use of tigecycline to treat VP shunt infections caused by daptomycin resistant VRE faecium.