Case of the Month - May 2022

Case of the Month - May 2022

Case Synopsis

A 55 year old man with hypertension presents to the emergency department with a one day history of headache, fever and neck stiffness. There is no preceding history of head trauma, neurosurgical devices or procedures. He denies recreational drug use. 

On physical examination, he is febrile with a temperature of 38.4°C and hemodynamically stable. Jolt accentuation test is positive and nuchal rigidity is present. No rash is present. No papilledema or focal neurological deficits are present, and he has no history of seizures. He has no known drug allergies. 

A lumbar puncture is performed, blood cultures are obtained, and he is empirically prescribed ceftriaxone, vancomycin, ampicillin, and dexamethasone, at appropriate dosing. His cerebrospinal fluid shows a leukocyte count of 2500 x106/L (normal 0-5) and 92% neutrophils, protein 3.0 g/L (normal 0.12-0.60), glucose 0.1 mmol/L (normal 2.8-4.5), and gram positive cocci are seen.

What is the BEST rationale for the use of vancomycin as part of this patient’s empiric antimicrobial regimen for community-acquired bacterial meningitis?