Nafcillin® and Rifampin® Therapy for MSSA Ventriculitis Associated With CSF Shunt; A Case Report (P3.310)

Nafcillin® and Rifampin® therapy for MSSA ventriculitis associated with CSF shunt; A case report Background; CSF shunt associated infection remains an important clinical complication that leads to malfunction and is an indication of shunt removal. The rate of internalized device infection ranges from 5 to 15 percent. The highest infection rates have been observed during the initial month after placement, in patients requiring serial revisions, and in patients undergoing revisions after treatment for an infected shunt. Case presentation; A 56 year old male with brain metastases and obstructive hydrocephalus, presents eight weeks after placement of a ventriculoperitoneal shunt device shunt with progressive lethargy, headache, and purulent discharge from the abdominal site of his VP shunt. Patient work up revealed positive Methicillin-sensitive Staphylococcus aureus culture obtained from the CSF as well as from his abdominal purulent collection. Patient had his VP shunt removed and IR guided drainage of his peritoneal fluid collection. The patient was started on IV Vancomycin® that was changed to Nafcilllin® based on his culture sensitivity results. Despite the parental treatment with Nafcillin® for one week and the removal of his VP shunt, the patient had persistently positive MSSA culture in his CSF with active signs of ventriculitis on neuroimaging studies. Oral Rifampin® was added to his regimen and 2 days later, all signs of CSF infection including his culture resolved. Patient was continued on this synergistic antimicrobial combination. Patient eventually underwent removal of his EVD with another internalized VP shunt placed and patient was discharged home with full course antibiotic treatment. This case demonstrates the challenging course of VP shunt-associated CNS infections. We report the first case of MSSA ventriculitis associated with a VP shunt resistant to Nafcillin® monotherapy but successfully treated with combination of Nafcilin® and Rifampin®. Disclosure: Dr. Goshgarian has nothing to disclose. Dr. Alwaki has nothing to disclose. Dr. Lugo has nothing to disclose. Dr. Abdelhak has nothing to disclose.