Neonate with Mycoplasma hominis meningoencephalitis given moxifloxacin

• Published in: The Lancet infectious diseases Vol. 16; no. 11; pp. e261 - e266
• Main Authors: Wildenbeest, Joanne G, Dr, Said, Ines, MD, Jaeger, Bregje, MD, van Hest, Reinier M, PharmD, van de Beek, Diederik, Prof, Pajkrt, Dasja, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.11.2016; Elsevier Limited
• Subjects: Acyclovir - therapeutic use; Amoxicillin - therapeutic use; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Antiviral Agents - therapeutic use; Blood; Cefotaxime - therapeutic use; Cerebrospinal Fluid - microbiology; Disease; Drug dosages; Female; Fever - etiology; Fluoroquinolones - pharmacokinetics; Fluoroquinolones - therapeutic use; Hospitals; Humans; Infant, Newborn; Infectious Disease; Infectious diseases; Laboratories; Meningitis; Meningoencephalitis - diagnosis; Meningoencephalitis - drug therapy; Meningoencephalitis - microbiology; Mortality; Mycoplasma hominis; Mycoplasma hominis - isolation & purification; Neonates; Pharmacokinetics; Polymerase Chain Reaction; Proteins; Ribosomal DNA; Streptococcus infections; Netherlands
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(16)30162-1

Summary Mycoplasma hominis is a commensal organism in the genitourinary tract that can cause life-threatening CNS infections in neonates after intrauterine infection or through vertical transmission during birth. We present a case of an 11-day-old neonate presenting with fever and supporting laboratory evidence of a CNS infection. No systemic maternal infection or maternal genitourinary tract infection occurred at the time of delivery. Empirical treatment was initiated, consisting of amoxicillin, cefotaxime, and aciclovir. After clinical deterioration, 16S ribosomal DNA PCR in cerebrospinal fluid detected M hominis , antibiotic treatment was switched to moxifloxacin, and pharmacokinetic data were obtained. This Grand Round illustrates the challenges that exist in the diagnosis and treatment of M hominis meningoencephalitis: bacterial cultures are often negative and recommended empirical antimicrobials do not provide adequate antimicrobial coverage. Optimal antimicrobial treatment regimens for M hominis meningoencephalitis are unknown. Although we describe successful treatment of a neonate with a complicated M hominis meningoencephalitis with moxifloxacin, caution with fluoroquinolone monotherapy (including moxifloxacin) has to be taken into account because resistance to fluoroquinolones has previously been described.