Central nervous system infections due to vancomycin-resistant enterococci: case series and review of the literature

Abstract

Objectives: To evaluate reported cases of central nervous system (CNS) infections due to vancomycin-resistant enterococci (VRE) and describe the data necessary to better understand clinical characteristics of this rare disease process.

Methods: We report two cases of VRE CNS infection and review 36 cases reported in the literature.

Results: Eighty-two percent (31/38) of cases were due to Enterococcus faecium. The median length of stay prior to diagnosis was 14 days (interquartile range 9-33). Fifty-eight percent (22/38) of cases had significant underlying non-malignant CNS disease processes and 63% (24/38) had CNS devices in situ. Forty percent (15/38) of patients had other positive culture sites. Ninety-two percent (35/38) of patients experienced microbiological cure and 74% (28/38) experienced clinical and microbiological cure following a variety of antimicrobial therapies. Seventy-four percent (14/19) of patients who experienced clinical/microbiological cure with CNS devices had them either removed or replaced. Eighteen percent (7/38) died from VRE CNS infections.

Conclusions: VRE CNS infections are uncommon nosocomial infections that most commonly affect patients with underlying CNS disease processes. The vast majority of cases are due to E. faecium, and many cases involve multiple positive culture sites. Optimal antimicrobial therapy remains undefined, but should be coupled with removal or replacement of indwelling CNS devices.

Keywords: Meningitis; Vancomycin-resistant enterococci; Ventriculitis.