Nosocomial Outbreak of Hepatitis E Infection in Pakistan with Possible Parenteral Transmission

unacceptably high rates of treatment failure [2, 3]. In vitro data indicate that the newer fluoroquinolones are active against Listeria species but have relatively poor penetration into the CNS, and ciprofloxacin used in a murine model of listeriosis was ineffective [4]. Linezolid is active against L. monocytogenes in vitro [5], and CSF concentrations of linezolid that are adequate for treatment have been attained in a rabbit model [6]. Additional data derived from the use of linezolid in neurosurgical settings, as well as the efficacy demonstrated in the treatment of CNS listeriosis in a murine model [7, 8], prompted us to use linezolid in the patient we describe. Rifampin crosses the blood-brain barrier, penetrates cell membranes, and is also active against L. monocytogenes. In a study of isolates recovered from patients with Listeria meningitis, rifampin and TMP-SMZ were the most potent monotherapeutic drugs tested [9]. Combination treatment involving rifampin and another active antimicrobial may reduce the emergence of resistance to rifampin. Our success with the combination of linezolid and rifampin may offer a valid alternative therapy for brain abscess caused by L. monocytogenes.