Abstract
Coagulase-negative staphylococci (CoNS) commonly infect Ommaya reservoirs, but data on intraventricular (IVT) vancomycin in neonates are very limited. We report a very preterm infant with oxacillin-resistant Staphylococcus hominis (ORSH) ventriculitis who was successfully treated with IVT vancomycin after systemic antibiotic failure. A female infant born at 29+2 weeks (birth weight 1,250 g) developed disseminated Candida albicans infection involving blood, central nervous system, eyes, and urinary tract. Progressive hydrocephalus required Ommaya reservoir placement at postmenstrual age of 37+2 weeks. Three weeks later, she developed ORSH ventriculitis. Intravenous vancomycin for 3 weeks followed by linezolid for 3 weeks failed to eradicate the infection. IVT vancomycin (5 mg every 48 h, 7 doses) was administered via the Ommaya reservoir together with systemic linezolid. The CSF vancomycin trough before the second dose was 18.56 μg/mL; subsequent troughs were 23.7 μg/mL and 18 μg/mL, suggesting a dose-related change in CSF vancomycin exposure. CSF cultures turned to negative after 5 IVT doses and remained negative on three consecutive samples. No ototoxicity or neurologic worsening was observed. IVT vancomycin at 5 mg every 48 h via an Ommaya reservoir may represent a safe and effective salvage treatment for CoNS ventriculitis in preterm infants when systemic antibiotics fail. Therapeutic drug monitoring (TDM) may be particularly important because CSF vancomycin levels vary greatly between individuals. This case provides one of the first serial CSF vancomycin trough measurements in a very preterm infant, suggesting a potential empiric starting approach for IVT vancomycin in this population.