Intraventricular vancomycin for Ommaya reservoir-associated
4 affiliations
- 1Department of Pharmacy, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 2Department of Neonatology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 3Department of Pharmacy, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Corresponding authors.
- 4Department of Neonatology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Corresponding authors.
Abstract
Objectives: Coagulase-negative staphylococci (CoNS) commonly infect Ommaya reservoirs, but data on intraventricular (IVT) vancomycin in neonates are very limited. We report a very preterm infant with oxacillin-resistant Staphylococcus hominis (ORSH) ventriculitis who was successfully treated with IVT vancomycin after systemic antibiotic failure. Design: A female infant born at 29 + 2 weeks (birth weight 1250 g) developed disseminated Candida albicans infection involving blood, central nervous system, eyes, and urinary tract. Progressive hydrocephalus required Ommaya reservoir placement at postmenstrual age of 37 + 2 weeks. Three weeks later, she developed ORSH ventriculitis. Results: Intravenous vancomycin for 3 weeks followed by linezolid for 3 weeks failed to eradicate the infection. IVT vancomycin (5 mg every 48 h, seven doses) was administered via the Ommaya reservoir together with systemic linezolid. The CSF vancomycin trough before the second dose was 18.56 μg/mL; subsequent troughs were 23.7 and 18 μg/mL, suggesting a dose-related change in CSF vancomycin exposure. CSF cultures turned to negative after five IVT doses and remained negative on three consecutive samples. No ototoxicity or neurologic worsening was observed. Conclusions: IVT vancomycin at 5 mg every 48 h via an Ommaya reservoir may represent a safe and effective salvage treatment for CoNS ventriculitis in preterm infants when systemic antibiotics fail. Therapeutic drug monitoring (TDM) may be particularly important because CSF vancomycin levels vary greatly between individuals. This case provides one of the first serial CSF vancomycin trough measurements in a very preterm infant, suggesting a potential empiric starting approach for IVT vancomycin in this population.
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BibTeX
@article{shen2026intraventricular,
title = {{Intraventricular vancomycin for Ommaya reservoir-associated}},
author = {Zexu Shen and Yating Song and Ze Yang and Shenmei Wang and Xiang Chen and Fei Bei and Zhiling Li and Xiuxia Ye},
journal = {International Journal of Infectious Diseases},
year = {2026},
month = oct,
doi = {10.1016/j.ijid.2026.109165},
url = {https://doi.org/10.1016/j.ijid.2026.109165},
note = {CC BY},
}
RIS
TY - JOUR
TI - Intraventricular vancomycin for Ommaya reservoir-associated
AU - Zexu Shen
AU - Yating Song
AU - Ze Yang
AU - Shenmei Wang
AU - Xiang Chen
AU - Fei Bei
AU - Zhiling Li
AU - Xiuxia Ye
PY - 2026
DA - 2026/10/30
JO - International Journal of Infectious Diseases
DO - 10.1016/j.ijid.2026.109165
UR - https://doi.org/10.1016/j.ijid.2026.109165
AB - Objectives: Coagulase-negative staphylococci (CoNS) commonly infect Ommaya reservoirs, but data on intraventricular (IVT) vancomycin in neonates are very limited. We report a very preterm infant with oxacillin-resistant Staphylococcus hominis (ORSH) ventriculitis who was successfully treated with IVT vancomycin after systemic antibiotic failure. Design: A female infant born at 29 + 2 weeks (birth weight 1250 g) developed disseminated Candida albicans infection involving blood, central nervous system, eyes, and urinary tract. Progressive hydrocephalus required Ommaya reservoir placement at postmenstrual age of 37 + 2 weeks. Three weeks later, she developed ORSH ventriculitis. Results: Intravenous vancomycin for 3 weeks followed by linezolid for 3 weeks failed to eradicate the infection. IVT vancomycin (5 mg every 48 h, seven doses) was administered via the Ommaya reservoir together with systemic linezolid. The CSF vancomycin trough before the second dose was 18.56 μg/mL; subsequent troughs were 23.7 and 18 μg/mL, suggesting a dose-related change in CSF vancomycin exposure. CSF cultures turned to negative after five IVT doses and remained negative on three consecutive samples. No ototoxicity or neurologic worsening was observed. Conclusions: IVT vancomycin at 5 mg every 48 h via an Ommaya reservoir may represent a safe and effective salvage treatment for CoNS ventriculitis in preterm infants when systemic antibiotics fail. Therapeutic drug monitoring (TDM) may be particularly important because CSF vancomycin levels vary greatly between individuals. This case provides one of the first serial CSF vancomycin trough measurements in a very preterm infant, suggesting a potential empiric starting approach for IVT vancomycin in this population.
SN - 1201-9712
SN - 1878-3511
ER -