Rifampin monotherapy for multidrug-resistant Chryseobacterium indologenes meningitis unresponsive to trimethoprim-sulfamethoxazole: a case report and review of the literature
Abstract
Multidrug-resistant (MDR) Chryseobacterium indologenes is an emerging pathogen causing challenging central nervous system (CNS) infections, for which there are no standardized treatment guidelines. A systematic review of the literature indicates that such infections are extremely rare. Although trimethoprim-sulfamethoxazole (TMP-SMX) is the most frequently reported first-line therapy, its clinical efficacy is not universal, posing a significant therapeutic challenge. We present the case of a 25-year-old postpartum woman who developed MDR C. indologenes meningitis and a brain abscess after undergoing a neurosurgical procedure. The infection did not respond to initial treatment with meropenem or a subsequent course of the first-line agent TMP-SMX. Based on antimicrobial susceptibility testing, therapy was switched to rifampin monotherapy, which led to rapid clinical and microbiological recovery. The patient completed a 24-day course of rifampin and remained recurrence-free during a 20-month follow-up. This is the first report of successful rifampin monotherapy for an MDR C. indologenes CNS infection in a patient unresponsive to TMP-SMX. When considered alongside existing literature, these findings highlight the essential role of susceptibility testing and establish rifampin as an important salvage therapy for this life-threatening infection, particularly when recommended first-line treatments fail.
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching
- Penicillins for Treatment of Pneumococcal Pneumonia: Does In Vitro Resistance Really Matter?
- Thiophenes—Naturally Occurring Plant Metabolites: Biological Activities and In Silico Evaluation of Their Potential as Cathepsin D Inhibitors
- Inhalable Mannosylated Rifampicin–Curcumin Co-Loaded Nanomicelles with Enhanced In Vitro Antimicrobial Efficacy for an Optimized Pulmonary Tuberculosis Therapy
- Development and validation of microbial bioassay for quantification of Levofloxacin in pharmaceutical preparations
- Association between cord blood 25-hydroxyvitamin D concentrations and respiratory tract infections in the first 6 months of age in a Korean population: a birth cohort study (COCOA)
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.