Ventriculitis and meningitis: by methicillin-resistant S. epidermidis : comparison of serum and CSF vancomycin concentrations and possible effect on MIC.

A case of HCAMV due to methicillin-resistant S. epidermidis (MRSE) in a new-born treated with vancomycin is described. Despite adequate vancomycin serum concentrations, an increase in vancomycin MIC (from 1 to 2 mg/L) in presence of persistently low CSF concentrations were observed. The eGFR during the treatment period was normal (no evidence of hyperfiltration). This report confirms the observation of a relationship among antibiotic PK/PD, cure of localized infections and resistance selection and specifically suggests the need for a first-line alternative to vancomycin in case of HCAMV due to CoNS with MIC ≥ 1 mg/L.