{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:31:39Z","timestamp":1792693899917,"version":"4.5.0"},"reference-count":35,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Ventriculitis and nosocomial meningitis caused by carbapenem-resistant Gram-negative and vancomycin-resistant Gram-positive bacteria represent a growing treatment challenge. A case of ventriculitis and bacteremia caused by carbapenem-resistant, KPC-producing Klebsiella pneumoniae and vancomycin-resistant Enterococcus faecium in a young woman with acute leukemia who was successfully treated with meropenem\/vaborbactam (MVB), rifampicin, and linezolid is described in this paper. This case report emphasizes the importance of a multidisciplinary strategy, including infectious focus control, for the treatment of device-associated central nervous system (CNS) infections from multidrug-resistant bacteria. Considering the novel resistance patterns, more research on drug penetration into the central nervous system, as well as on the necessity of association therapies, is needed.<\/jats:p>","DOI":"10.3390\/antibiotics13050432","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T05:25:47Z","timestamp":1715318747000},"page":"432","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A Difficult Case of Ventriculitis in a 40-Year-Old Woman with Acute Myeloid Leukemia"],"prefix":"10.3390","volume":"13","author":[{"given":"Raffaella","family":"Rubino","sequence":"first","affiliation":[{"name":"Infectious and Tropical Diseases Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"},{"name":"Antimicrobial Stewardship Team, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8105-5139","authenticated-orcid":false,"given":"Marcello","family":"Trizzino","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1871-4285","authenticated-orcid":false,"given":"Luca","family":"Pipit\u00f2","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. 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Giaccone\u201d, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico Gerardo","family":"Iacopino","sequence":"additional","affiliation":[{"name":"Neurosurgical Clinic, AOU Policlinico \u201cP. Giaccone\u201d, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7874-6289","authenticated-orcid":false,"given":"Giovanni Maurizio","family":"Giammanco","sequence":"additional","affiliation":[{"name":"UOC of Microbiology, Virology and Parasitology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. 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Giaccone\u201d, 90127 Palermo, Italy"},{"name":"Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e34","DOI":"10.1093\/cid\/ciw861","article-title":"2017 Infectious Diseases Society of America\u2019s clinical practice guidelines for healthcare-associated ventriculitis and meningitis","volume":"64","author":"Tunkel","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_2","unstructured":"Harris, L., and Munakomi, S. (2024). StatPearls, StatPearls Publishing."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"697","DOI":"10.2147\/IDR.S326456","article-title":"Current perspectives on the diagnosis and management of healthcare-associated ventriculitis and meningitis","volume":"15","author":"Karvouniaris","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3807","DOI":"10.2147\/IDR.S416948","article-title":"Treatment of ventriculitis and meningitis after neurourgery caused by carbapenem-resistant Enterobacteriaceae (cre): A challenging topic","volume":"16","author":"Li","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"ref_6","unstructured":"(2024, April 22). Available online: https:\/\/www.epicentro.iss.it\/antibiotico-resistenza\/cre-dati."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"ciad428","DOI":"10.1093\/cid\/ciad428","article-title":"Infectious Diseases Society of America 2023 Guidance on the treatment of antimicrobial resistant Gram-negative infections","volume":"77","author":"Tamma","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.cmi.2021.11.025","article-title":"European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli (endorsed by European society of intensive care medicine)","volume":"28","author":"Paul","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_9","unstructured":"Tiseo, G., Brigante, G., Giacobbe, D.R., Maraolo, A.E., Gona, F., Falcone, M., Giannella, M., Grossi, P., Pea, F., and Rossolini, G.M. (2024, April 22). Diagnosi e Management Delle Infezioni Causate da Batteri Multiresistenti: Linee Guida Della Societ\u00e0 Italiana di Malattie Infettive e Tropicali (SIMIT), Societ\u00e0 Italiana di Terapia Antinfettiva (SITA), Gruppo Italiano per la Stewardship Antimicrobica (GISA), Associazione Microbiologi Clinici Italiani (AMCLI), Societ\u00e0 Italiana di Microbiologia (SIM). Available online: https:\/\/www.iss.it\/documents\/20126\/8331678\/LG+557+Intersocietarie_MDR.pdf\/8b89a49e-6f57-ff09-6e73-c9eb4773aefc?t=1699024001755."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.ijid.2022.07.073","article-title":"A post-neurosurgical infection due to KPC-producing Klebsiella pneumoniae treated with meropenem-vaborbactam: A case report","volume":"122","author":"Choi","year":"2022","journal-title":"Int. J. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"ofaa349","DOI":"10.1093\/ofid\/ofaa349","article-title":"Using therapeutic drug monitoring to treat KPC-producing Klebsiella pneumoniae central nervous system infection with ceftazidime\/avibactam","volume":"7","author":"Yasmin","year":"2020","journal-title":"Open Forum Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e00963","DOI":"10.1016\/j.idcr.2020.e00963","article-title":"Carbapenemase producing Klebsiella pneumoniae (KPC) meningitis from chronic otitis media","volume":"22","author":"Anwar","year":"2020","journal-title":"IDCases"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jgar.2024.03.003","article-title":"Simultaneous post-neurosurgical ventriculitis and bacteremia by two different strains of KPC-producing K. pneumoniae successfully treated with meropenem\/vaborbactam and high dose of fosfomycin","volume":"37","author":"Volpicelli","year":"2024","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Nau, R., Seele, J., and Eiffert, H. (2024). New antibiotics for the treatment of nosocomial central nervous system infections. Antibiotics, 13.","DOI":"10.3390\/antibiotics13010058"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Rezzonico, L.F., Peracchi, F., Vecchi, M., Bassi, G., Merli, M., Bana, N.B., Travi, G., Crippa, F., and Puoti, M. (2024). Meropenem\u2013vaborbactam for the treatment of post-neurosurgical meningitis caused by KPC producer Klebsiella pneumoniae: A case report and review of the literature. Antibiotics, 13.","DOI":"10.3390\/antibiotics13040331"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1093\/jac\/dkx358","article-title":"Ceftazidime\/avibactam use for carbapenem-resistant Klebsiella pneumoniae meningitis: A case report","volume":"73","author":"Holyk","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gatti, M., Virgili, G., Cojutti, P.G., Gaibani, P., Conti, M., Sturiale, C., Pea, F., and Viale, P. (2022). Real-time optimization of pharmacodynamic target attainment at infection site during treatment of post-neurosurgical ventriculitis caused by carbapenem-resistant gram negatives with ceftazidime\u2013avibactam-based regimens: A report of two cases. Microorganisms, 10.","DOI":"10.3390\/microorganisms10010154"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s00701-019-03801-y","article-title":"Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: Prospective observational cohort study","volume":"161","author":"Hussein","year":"2019","journal-title":"Acta Neurochir."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s00701-020-04611-3","article-title":"Extensively drug-resistant and multidrug-resistant gram-negative pathogens in the neurocritical intensive care unit","volume":"164","author":"Munari","year":"2020","journal-title":"Acta Neurochir."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.3389\/fneur.2018.01174","article-title":"outcome following the treatment of ventriculitis caused by multi\/extensive drug resistance Gram negative Bacilli; Acinetobacter baumannii and Klebsiella pneumoniae","volume":"9","author":"Pandey","year":"2019","journal-title":"Front. Neurol."},{"key":"ref_21","unstructured":"(2024, April 22). Available online: https:\/\/qlik.qualitasiciliassr.it\/anonimo\/single\/?appid=85ada16c-4b41-4bc6-9ca1-405b8243d0c2&sheet=6ad6f3ac-3369-41c5-bd72-792243f9091b&opt=ctxmenu,currsel."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"102","DOI":"10.4103\/ajns.AJNS_260_17","article-title":"Enterococcal Meningitis\/Ventriculitis: A Tertiary Care Experience","volume":"14","author":"Khanum","year":"2019","journal-title":"Asian J. Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Cearns, M.D., McLintock, B.T., Suttner, N., and Khalsa, K. (2022). Successful treatment of vancomycin-resistant enterococcal infection of an external ventricular drain with 2 weeks of intravenous linezolid. Access Microbiol., 4.","DOI":"10.1099\/acmi.0.000335"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.wneu.2019.01.065","article-title":"Intravenous and intraventricular daptomycin plus intravenous linezolid treatment of an infant with vancomycin-resistant enterococci-induced ventriculoperitoneal shunt infection","volume":"124","author":"Dalgic","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ijid.2014.01.009","article-title":"Central nervous system infections due to vancomycin-resistant enterococci: Case series and review of the literature","volume":"25","author":"Wang","year":"2014","journal-title":"Int. J. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"131","DOI":"10.3109\/00365548.2012.717711","article-title":"Vancomycin-resistant Enterococcus faecium meningitis in adults: Case series and review of the literature","volume":"45","author":"Knoll","year":"2013","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Haddad, N., Carr, M., Balian, S., Lannin, J., Kim, Y., Toth, C., and Jarvis, J. (2022). The Blood\u2013Brain Barrier and Pharmacokinetic\/Pharmacodynamic Optimization of Antibiotics for the Treatment of Central Nervous System Infections in Adults. Antibiotics, 11.","DOI":"10.3390\/antibiotics11121843"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1186\/s13054-016-1523-y","article-title":"Cerebrospinal fluid penetration of meropenem in neurocritical care patients with proven or suspected ventriculitis: A prospective observational study","volume":"20","author":"Blassmann","year":"2016","journal-title":"Crit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1048653","DOI":"10.3389\/fphar.2022.1048653","article-title":"Cerebrospinal fluid concentrations of fluoroquinolones and carbapenems in tuberculosis meningitis","volume":"13","author":"Maranchick","year":"2022","journal-title":"Front. Pharmacol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1007\/s00701-018-3680-z","article-title":"Intrathecal penetration of meropenem and vancomycin administered by continuous infusion in patients suffering from ventriculitis\u2014A retrospective analysis","volume":"160","author":"Mader","year":"2018","journal-title":"Acta Neurochir."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e0043822","DOI":"10.1128\/aac.00438-22","article-title":"Meropenem population pharmacokinetics and simulations in plasma, cerebrospinal fluid, and brain tissue","volume":"66","author":"Alshaer","year":"2022","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1002\/phar.2210","article-title":"Pharmacokinetics and pharmacodynamics of \u03b2-lactamase inhibitors","volume":"39","author":"Crass","year":"2019","journal-title":"Pharmacotherapy"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1128\/CMR.00007-10","article-title":"Penetration of drugs through the blood-cerebrospinal fluid\/blood-brain barrier for treatment of central nervous system infections","volume":"23","author":"Nau","year":"2010","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_34","first-page":"w20208","article-title":"Management of neurosurgical implant-associated infections","volume":"150","author":"Conen","year":"2020","journal-title":"Swiss Med. Wkly."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1086\/500139","article-title":"Efficacy and safety of linezolid compared with vancomycin in a randomized, double-blind study of febrile neutropenic patients with cancer","volume":"42","author":"Jaksic","year":"2006","journal-title":"Clin. Infect. 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