Treatment Optimization by Monitoring Vancomycin Concentration in the Serum and Cerebrospinal Fluid in a Child with Cystoperitoneal Shunt-related Infection Caused by Methicillin-resistant Staphylococcus aureus: A case report

Background: Cerebral ventricular shunt infections caused by methicillin-resistant Staphylococcus aureus (MRSA), especially strains with elevated minimal inhibitory concentration (MIC) values, have a poor prognosis. Monitoring serum vancomycin (VCM) levels with therapeutic drug monitoring and maintaining high VCM concentrations in the cerebrospinal fluid (CSF) are critical to treatment success. However, there have been a few reports about CSF penetration and the pharmacokinetics of VCM in children. Case presentation Here, we report a pediatric case with cystoperitoneal shunt-related meningitis caused by MRSA with an MIC of 2 µg/mL. The adequate VCM concentration was maintained by monitoring the VCM concentration in the CSF via the external ventricular drain, and frequent blood taking was avoided. VCM showed a good CSF penetration in our patient, and she was discharged without complications. Conclusions Therapeutic drug monitoring of VCM concentration in the CSF may result in successful treatment even if MRSA shows a higher MIC. Therapeutic drug monitoring of VCM concentration in the CSF may also reduce the frequency of blood collection and side effects.