Abstract
Background: To investigate the efficacy of linezolid in the treatment of intracranial infection caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant coagulase-negative Staphylococcus (MRCoNS).Case presentation: The patient at our hospital was diagnosed with methicillin-resistant Staphylococcus epidermidis (MRSE) intracranial infection, which was resistant to oxacillin and sensitive to vancomycin (MIC = 2 µg/mL) and linezolid (MIC = 4 µg/mL). Vancomycin was replaced with linezolid after 36 days of treatment due to poor outcome, and the patient was eventually cured. Further, a total of 23 cases of intracranial MRSA/MRCoNS infections were reported, of which 1 case with MRSA had a vancomycin MIC = 1 µg/mL, while the remaining 22 cases had vancomycin MICs greater than 1 µg/mL, with MIC = 1.5 µg/mL in 1 case, MIC = 2 µg/mL in 19 cases and MIC = 4 µg/mL in 2 cases. The linezolid-containing regimen was used after drug susceptibility results or if the initial treatment failed, leading to recovery in 19 patients, microbial clearance in 3 patients (of which 2 patients died of comorbidities and 1 patient died of Pseudomonas aeruginosa infection), and treatment failure in 1 case.Conclusion: The PK/PD parameter for evaluating the efficacy of vancomycin is AUC/MIC ≥ 400 (assuming a vancomycin MICBMD of 1 µg/mL), and trough concentration should not be used as a substitute for AUC/MIC. For optimal management, vancomycin dosing should be based on AUC-guided dosing and monitoring. When the vancomycin MIC of MRSA/MRCoNS is > 1 µg/mL, the target AUC/MIC cannot be achieved. In such cases, linezolid can be used with good therapeutic effects.
Treatment of Intracranial Infection Caused by Methicillin-Resistant Staphylococcus epidermidis with Linezolid Following Poor Outcome of Vancomycin Therapy: A Case Report and Literature Review
