cefotaxime and Meningitis--Bacterial

Defined by an infection of the ventricular system of the brain, ventriculitis is usually known as a health-care associated infection. In contrast, primary pyogenic ventriculitis complicating community-acquired meningitis is uncommon, and mainly described in infants. Only seven cases that have occured in adults have been found in the international literature.. We report here a new case due to Neisseria meningitidis occurring in an 85 year-old-man. The comparison with previous reports allows to drawn several conclusions: (i) cases occurred in relatively old adults (median age: 65 years); (ii) Streptococcus pneumoniae, N. meningitiditis and Staphylococcus aureus are the leading responsible pathogens; (iii) atypical clinical presentation seems the rule in which meningism often lacks; (iv) in absence of clinical or biological specific parameters, modern brain imaging such as magnetic resonance imaging with gadolinium enhancement is of utmost importance for the diagnosis, leading to anticipate an increase of the diagnosis in the near future, thanks to easier access to such exploration; (v) death or serious sequelae commonly occurred; (vi) prolonged antibiotic courses (6 weeks to 3 months) have been used, without strong rational. In the given case, the patient presented with a lack of meningeal irritation signs. The diagnosis was made by MRI considering a lasting confused state. A four-week antibiotic regimen was successful, combining two weeks of intravenous cefotaxime followed by two weeks of oral levofloxacin much easier to administrate and allowing early rehabilitation.. Primary bacterial ventriculitis is a real diagnosis challenge. Larger indications of MRI for bacterial meningitis, particularly in cases with an atypical presentation or poor evolution would certainly increase the number of diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Brain; Cefotaxime; Cerebral Ventricles; Cerebral Ventriculitis; Communicable Disease Control; Encephalitis; Humans; Infectious Disease Medicine; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Middle Aged; Neisseria meningitidis; Staphylococcal Infections; Staphylococcus aureus; Streptococcus pneumoniae

A 51-year-old man with no underlying disease was referred to our hospital, complaining of mild headache. In May 2004 he developed headache of sudden onset in the occipital region and neck pain. He visited our hospital the following morning. At the first visit, there was no fever and only an analgesic was prescribed. The headache alleviated, with only occasional mild episodes thereafter. However, 2 days later, the headache aggravated again, associated this time with elevated body temperature (38 degrees C). The patient visited our hospital and a lumbar puncture was performed; examination of the cerebrospinal fluid revealed marked elevation of the cell count (mononuclear cell-dominant). The patient was admitted to the hospital and started on treatment with cefotaxime and acyclovir. However, the symptoms persisted and 10 days later, the cerebrospinal fluid culture yielded a growth of Campylobacter jejuni (C. jejuni). The antibiotic was therefore changed to panipenem, which resulted in prompt resolution of the symptoms. To the best of our knowledge, meningitis caused by C. jejuni in an immunocompetent adult is extremely rare. This case highlights the importance of bearing in mind the possibility of C. jejuni meningitis in a patient of meningitis associated with mononuclear cell-dominant pleocytosis of the cerebrospinal fluid.

Topics: Acyclovir; Campylobacter Infections; Campylobacter jejuni; Cefotaxime; Diagnosis, Differential; Drug Therapy, Combination; Humans; Immunocompetence; Male; Meningitis, Bacterial; Middle Aged; Thienamycins; Treatment Outcome

Group A streptococcus is an uncommon cause of meningitis in children. We report a single case of Group A streptococcus meningitis, in an apparently healthy 6-week-old infant. Twenty-five cases in the English-language literature in the last 25 years and our case are reviewed. The commonest associated illness was otitis media. Of the 25 patients, 24 survived. Antibiotic therapy, which consisted of penicillin in the majority of patients, was effective. Ceftriaxone was an alternative agent. Neurological sequelae were not uncommon. This report emphasizes the fact that Group A streptococcus can cause meningitis in healthy children without apparent recognizable foci of infection.

Topics: Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Dexamethasone; Drug Therapy, Combination; Female; Humans; Infant; Infusions, Intravenous; Meningitis, Bacterial; Penicillins; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Capnocytophaga canimorsus causes dog-bite wound induced sepsis in adults, but infection may follow mucous membrane exposure. Systemic infection in children is extremely rare. A neonate with frequent exposure to a family dog and no cutaneous infection developed C. canimorsus meningitis. Suspicion of this pathogen requires laboratory consultation. Parental counseling can limit the risk of pet acquired infections.

Topics: Ampicillin; Animals; Capnocytophaga; Cefotaxime; Dogs; Drug Therapy, Combination; Female; Follow-Up Studies; Gentamicins; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Infusions, Intravenous; Meningitis, Bacterial; Risk Assessment; Treatment Outcome

A case of meningitis caused by Streptococcus Equisimilis and cerebrospinal fluid rhinorrhea, in which the head trauma occurred 16 years before, is presented. To the best of the author's knowledge this is the first case reported with such characteristics. Several precipitating factors could be responsible for the unusually late reopening of the fistula Streptococci equisimilis is an uncommon cause of the bacteremia. An appropriate antimicrobrial therapy against S. Equisimilis followed by surgical dural repair were performed.

Topics: Brain Injuries; Cefotaxime; Cerebrospinal Fluid Rhinorrhea; Drug Therapy, Combination; Frontal Lobe; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Middle Aged; Neurosurgical Procedures; Sphenoid Sinus; Streptococcal Infections; Streptococcus; Time Factors; Tomography, X-Ray Computed; Vancomycin

Topics: Ampicillin; Anti-Bacterial Agents; Bacteremia; Cefotaxime; Central Nervous System Bacterial Infections; Female; Humans; MEDLINE; Meningitis, Bacterial; Middle Aged; Streptococcus bovis

Because the introduction of extended spectrum cephalosporins into pediatric practice offers a number of choices for treatment, we review efficacy studies of cefepime monotherapy in the treatment of bacterial meningitis in children.. Two open, randomized, comparative studies assessed the efficacy of cefepime empiric monotherapy in the treatment of bacterial meningitis in 345 pediatric patients. These studies were conducted in Latin America and compared cefepime (50 mg/kg/dose every 8 h) with either cefotaxime (50 mg/kg/dose every 6 h) or ceftriaxone (50 mg/kg/dose every 12 h). Patients 2 months to 14 years old who had clinical signs and symptoms consistent with a central nervous system infection were enrolled. Efficacy was based on clinical and bacteriologic response.. Integrated results from the Latin American studies indicated a 75% cure rate with cefepime vs. a 78% cure rate with comparator, among evaluable patients. Overall the rate of treatment failure was 12%. Haemophilus influenzae had the highest bacterial eradication rate (97% overall), and rates were comparable in cefepime and comparator arms. Eradication rates for Neisseria meningitidis were equally high in both treatment arms (95% overall), and the eradication rate for Streptococcus pneumoniae was 92% overall. Of the patients with S. pneumoniae isolated during pretreatment (from either cerebrospinal fluid or blood), 11 (16 isolates in total) had their isolates tested against penicillin and all were susceptible. Presence or absence of seizures, level of consciousness, Glasgow Coma Score and duration of signs and symptoms were strong predictors of outcome. Collectively no specific safety concerns were identified.. Cefepime represents an important therapeutic option for the empiric treatment of bacterial meningitis in children, based on the good clinical response and bacteriologic eradication rates observed in this review.

Topics: Adolescent; Cefepime; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Humans; Infant; Latin America; Meningitis, Bacterial; Randomized Controlled Trials as Topic; Safety; Treatment Failure; Treatment Outcome

Group C streptococci are a common cause of epidemic bacterial infection in animals. These organisms are a rare but frequently fatal cause of meningitis in humans. We report the case of a 13-year-old girl with meningitis caused by a group C Streptococcus (Streptococcus zooepidemicus) successfully treated with vancomycin and third generation cephalosporins. We also review cases of group C streptococcal meningitis reported previously.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Drug Therapy, Combination; Female; Humans; Meningitis, Bacterial; Streptococcal Infections; Streptococcus equi; Vancomycin

A case of group A streptococcal meningitis is reported and the 51 cases reported in the literature since 1966 reviewed. A total of 24 men and 24 women were included in the study; the mean age (+/-SD) was 20.9+/-25.5 years. Fifty-eight percent of the patients had comorbid conditions, 80% had a distant focus of infection, and 65.8% had blood cultures positive for group A streptococci. Seventy-five per cent of the patients were treated with penicillin. The overall case-fatality rate was 12% (6 patients). Sequelae were more prevalent among children (44%) than among adults (7.7%) (OR=9.43; 95% CI, 1.02-438.95; P=0.03). Group A streptococcus is a rare cause of pyogenic meningitis, affecting mainly children or adults with comorbidity. Although the case-fatality rate is relatively low, neurological sequelae are frequent among survivors, especially children.

Topics: Adult; Aged; Cefotaxime; Cephalosporins; Female; Follow-Up Studies; Humans; Male; Meningitis, Bacterial; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Spontaneous disappearance of an arachnoid cyst is very rare, particularly after suppurative meningitis.. A 2-month-old boy with a high fever was diagnosed with suppurative meningitis by cerebrospinal fluid examination. Computed tomography disclosed a large arachnoid cyst in the left middle cranial fossa. Two months later, the meningitis was cured. The arachnoid cyst disappeared with long-term antibiotic therapy alone.. Although an infected arachnoid cyst may disappear with antibiotic treatment alone, careful observation and individualized patient management are essential.

Topics: Arachnoid Cysts; Cefotaxime; Cephalosporins; Haemophilus Infections; Humans; Infant; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Penicillins; Remission, Spontaneous; Skull; Tomography, X-Ray Computed

Moraxella catarrhalis has been reported with increasing frequency to be the aetiological agent of serious systemic infection in both children and adults. The first case of neonatal meningitis due to this organism is described herein. The fatal outcome and causes of failure of response to antimicrobial therapy are also discussed. A brief review of the literature describing the disease entities with which M. catarrhalis has been associated is presented.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Drug Therapy, Combination; Fatal Outcome; Gentamicins; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Moraxella catarrhalis; Neisseriaceae Infections; Penicillins

The carbapenem class of antibacterial agents is highly effective in vitro against the bacterial pathogens causing meningitis. Both imipenem and meropenem penetrate into the cerebrospinal fluid of children with inflamed meninges in the acute phase of meningitis. The wider clinical use of imipenem/cilastatin for the treatment of meningitis has been limited by the high incidence of seizures (up to 33%) in patients not having seizures prior to drug therapy. However, imipenem/cilastatin has been successfully used for the treatment of pneumococcal meningitis following failure of treatment with third-generation cephalosporins. The bacteriological and clinical efficacy of meropenem appears similar to that of cefotaxime in the management of meningitis in children and there was no significant propensity of either meropenem or cefotaxime to cause seizures. Meropenem has also been usefully employed to treat multi-resistant Pseudomonas aeruginosa meningitis. These data suggest that meropenem should be further investigated for use in the treatment of meningitis.

Topics: Animals; Brain; Carbapenems; Cefotaxime; Cerebrospinal Fluid; Child; Child, Preschool; Drug Resistance, Microbial; Humans; Meningitis, Bacterial; Rabbits

We report a case of postoperative wound infection and meningitis with Salmonella typhimurium in a 66-year-old woman who had been operated on for a cerebral meningioma. The diagnostic, therapeutic and prognostic implications are discussed.

Topics: Aged; Cefotaxime; Combined Modality Therapy; Craniotomy; Female; Humans; Meningeal Neoplasms; Meningioma; Meningitis, Bacterial; Recurrence; Reoperation; Salmonella typhimurium; Surgical Wound Infection

Topics: Cefotaxime; Ceftriaxone; Chemotherapy, Adjuvant; Child; Dexamethasone; Drug Administration Schedule; Humans; Infant; Meningitis, Bacterial; Spinal Puncture

New antimicrobials or adjunctive treatments have not substantially reduced mortality from acute childhood bacterial meningitis. Paracetamol seems to have beneficial effects in bacteraemic adults and some experts recommend initial slow β-lactam infusion. We investigated whether these treatments had benefits in children with bacterial meningitis.. We did a prospective, double-blind, single-centre study with a two-by-two factorial design in Luanda, Angola. 723 participants aged 2 months to 13 years were randomly assigned two 12 h intravenous infusions, without loading doses, of 125 mg/kg bodyweight cefotaxime (total dose 250 mg/kg) given over 24 h, or 250 mg/kg bodyweight cefotaxime given as four boluses, one every 6 h over 24 h. Patients also received oral paracetamol at an initial dose of 30 mg/kg then 20 mg/kg every 6 h for 48 h or placebo. Two primary endpoints, death or severe neurological sequelae and deafness, were analysed by intention to treat. The study was registered as ISRCTN62824827.. 183 patients were assigned cefotaxime infusion plus paracetamol and 180 patients to each of the other three treatment groups. Causative agents were identified in 63% of cases and were mostly Haemophilus influenzae type b, Streptococcus pneumoniae, or Neisseria meningitidis. Death or severe neurological sequelae were seen in 340 (47%) of 723 children and deafness in 45 (12%) of 374 tested, both distributed similarly across treatment groups. In a predefined subgroup analysis of death or any sequelae, by causative agent, a benefit was seen in favour of infusion over bolus in children with pneumococcal meningitis (infusion plus placebo, odds ratio 0·18, 95% CI 0·03-0·90, p=0·04). A similar effect was seen for children receiving cefotaxime infusion plus paracetamol, but the difference was not significant (OR 0·22, 95% CI 0·04-1·09, p=0·06). A post-hoc analysis suggested that cefotaxime infusion plus paracetamol lowered mortality at least during the first 3 days, irrespective of cause.. Although no tested regimen improved the final outcomes of these very ill children, studies of longer courses of β-lactam infusion plus paracetamol seem warranted.. The Päivikki and Sakari Sohlberg, the Sigrid Jusélius, and the Paediatric Research Foundations, and the daily newspaper Helsingin Sanomat.

Topics: Acetaminophen; Adolescent; Angola; Anti-Infective Agents; Antipyretics; Cefotaxime; Child; Child, Preschool; Double-Blind Method; Drug Therapy, Combination; Female; Gram-Positive Bacteria; Humans; Infant; Infusions, Intravenous; Kaplan-Meier Estimate; Logistic Models; Male; Meningitis, Bacterial; Prospective Studies

Cefotaxime (CTX) and ceftriaxone (CRO) were compared for cerebrospinal fluid (CSF) penetration and antimicrobial efficacy in cases of bacterial meningitis in children. This was a comparative study of CRO (100mg/kg once daily) and CTX (50 mg/kg 6 hourly) in the treatment of children with bacterial meningitis. The aetiological agents included Streptococcus pneumoniae (SPn), Haemophilus influenzae type b (Hib) and Neisseria meningitidis (NMen). Minimum inhibitory concentrations (MICs) were measured. In 33 patients from whom a second CSF specimen was obtained, CSF was cultured and assayed for antibiotic concentration. Median MICs of CTX and CRO for SPn, Hib and NMen were 0.01 and 0.01 microg/mL, 0.004 and 0.002 microg/mL and 0.008 and 0.004 microg/mL, respectively. All 33 repeat lumbar puncture specimens were sterile. The lowest CSF level recorded (0.45 microg/mL for CTX) was 45 times the MIC (0.01 microg/mL). The highest levels (24-35 microg/mL for CRO) were up to 8750 times the MIC of the patient's causative organism. A wide range of CSF levels for both antibiotics was observed. Levels varied with post-dose interval and duration of illness. On the basis of these findings, clinicians should be reassured that repeat lumbar puncture is not recommended for the causative organisms in this study (i.e., for Hib, NMen and penicillin/cefotaxime/ceftriaxone fully-susceptible SPn).

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Female; Haemophilus influenzae type b; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal

To compare the efficacy and safety of meropenem with cefotaxime for the treatment of infants and children with bacterial meningitis.. Infants and children with strongly suspected or documented bacterial meningitis were randomly assigned in a prospective multicenter study to receive either meropenem or cefotaxime. Patients were assessed at the end of therapy and at 5 to 7 weeks and 5 to 7 months after the end of treatment for the presence of neurologic and sensory neural sequelae.. A total of 258 children were randomized to either treatment group. A further 8 patients with suspected pneumococcal meningitis were treated with meropenem without randomization. Of the randomized patients 154 were fully evaluable, 79 in the meropenem group and 75 in the cefotaxime group. At the end of treatment there were no significant differences in clinical outcome between the two treatment groups. Clinical cure with or without sequelae was achieved in 97 and 96% of the meropenem- and cefotaxime-treated patients, respectively. At the end of treatment and at 5 to 7 weeks, 46 and 54% of meropenem patients were cured with no sequelae, respectively. Corresponding results for cefotaxime patients were 56 and 58%. All pathogens were eradicated. In total 37 patients had seizures during treatment, 15 (12%) in the meropenem and 22 (17%) in the cefotaxime group. None of the seizures was considered to be drug-related.. This trial shows that meropenem is suitable therapy for bacterial meningitis in infants and children and that it offers an efficacy and safety profile similar to that of cefotaxime.

Topics: Cefotaxime; Cephalosporins; Child; Child, Preschool; Female; Humans; Infant; Male; Meningitis, Bacterial; Meropenem; Prospective Studies; Single-Blind Method; Thienamycins; Treatment Outcome

Seventy five patients of acute bacterial meningitis, aged 12 to 70 years, were randomized to two treatment groups. In addition to standard antibiotic therapy, one group received dexamethasone in a dose of 8 mg, 6 hourly for 7 days. The main outcome measures used were (a) Rapidity of recovery parameters, namely, time to defervesence, disappearance of neck rigidity and return of consciousness (b) Incidence of neurological complications during hospitalization and follow-up (c) Mortality. There were no significant differences in outcome between the two treatment groups in any of the clinical parameters assessed. The use of dexamethasone as an adjunct does not speed recovery from acute illness and does not reduce the incidence of neurological complications or death in adult patients with acute bacterial meningitis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Cefotaxime; Chi-Square Distribution; Child; Dexamethasone; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Infusions, Intravenous; Male; Meningitis, Bacterial; Middle Aged; Probability; Prognosis; Survival Rate; Treatment Outcome

Broad-spectrum cephalosporins are drugs of choice for the treatment of meningitis in communities which can afford them. The emergence of cephalosporin-resistant pneumococci demands the clinical trial of alternate agents. Carbapenems are active against the bacteria causing meningitis, but the use of imipenem-cilastatin was frustrated by drug-associated seizures. The safety and efficacy of meropenem, a new carbapenem, were compared to those of cefotaxime in a prospective randomized trial of 190 children with bacterial meningitis. Seizures occurred within 24 h before antibiotic therapy in 16 of 98 patients (16%) randomized to receive meropenem and in 6 of 92 patients (7%) randomized to receive cefotaxime. In patients without seizures before therapy, seizures occurred during therapy in 5 of 82 patients (6%) receiving meropenem and in 1 of 86 patients (1%) receiving cefotaxime (95% confidence interval: -0.7%, 10.6%). None were thought to be drug related. Twenty-four meropenem-treated patients (24%) and 11 cefotaxime-treated patients (12%) had neurological abnormalities before therapy. In patients without pretherapy neurological abnormalities, these abnormalities were present after treatment in 4 of 74 meropenem-treated patients (5%) and in 2 of 81 cefotaxime-treated patients (2%) (95% confidence interval: -3.2%, 9.1%). Of 75 meropenem-treated and 64 cefotaxime-treated patients with pretherapy positive cerebrospinal-fluid cultures, 68 and 59, respectively, had repeat lumbar punctures. Bacterial eradication was found to be 100% in both groups. Our data suggest that meropenem may be a carbapenem agent that is well tolerated and effective in the treatment of bacterial meningitis.

Topics: Adolescent; Cefotaxime; Child; Child, Preschool; Dexamethasone; Female; Hearing Tests; Humans; Infant; Male; Meningitis, Bacterial; Meropenem; Nervous System Diseases; Prospective Studies; Seizures; Thienamycins; Treatment Outcome

Ninety infants and children were prospectively randomized to receive cefepime (n = 43) or cefotaxime (n = 47) for therapy of bacterial meningitis. The two treatment groups were comparable in terms of age, duration of illness before enrollment, history of seizures, clinical status on admission, and etiology. Six (7%) patients died--two treated with cefepime and four treated with cefotaxime. Clinical response, cerebrospinal fluid sterilization, development of complications, antibiotic toxicity, and hospital stay were similar for the two treatment regimens. Concentrations of cefepime in cerebrospinal fluid varied from 55 to 95 times greater than the maximal MIC required by the causative pathogens. Audiologic and/or neurologic sequelae were found in 16% of the cefepime-treated patients and 15% of the cefotaxime-treated patients examined 2 to 6 months after discharge. We conclude that cefepime is safe and therapeutically equivalent to cefotaxime for management of bacterial meningitis in infants and children.

Topics: Adolescent; Cefepime; Cefotaxime; Cephalosporins; Child; Child, Preschool; Humans; Infant; Meningitis, Bacterial; Prospective Studies

Third-generation cephalosporins are presently the agents of choice for the empirical antimicrobial therapy of bacterial meningitis. However, a number of factors associated with these agents, namely the development of resistance by pneumococci, limited activity against some Enterobacteriaceae and Pseudomonas spp., and the possible adverse effects of their bacteriolytic mode of action, indicate that newer classes of antimicrobial agents be evaluated for the treatment of bacterial meningitis. Meropenem is a carbapenem antibiotic which is highly active against the major bacterial pathogens causing meningitis, and penetrates well into the cerebrospinal fluid. Two prospective randomised studies in 56 adult bacterial meningitis patients have compared meropenem 40 mg/kg 8-hourly, up to a maximum of 6 g/day (n = 28) with cephalosporin treatment, i.e. cefotaxime (n = 17) or ceftriaxone (n = 11). Patients were assessed by neurological examination, Glasgow Coma Score and Herson-Todd score. Clinical cure was observed in all 23 evaluable patients treated with meropenem (100%) and with 17 of the 22 evaluable cephalosporin-treated patients (77%). All pre-treatment isolates were eradicated except one isolate of Staphylococcus aureus in a cefotaxime-treated patient. Neurological sequelae were noted in three meropenem and four cephalosporin-treated patients. No patients in either treatment group experienced seizures after the start of therapy. This was despite the fact that a patient in each group had experienced seizures before therapy, several had underlying CNS disorders, and that doses of 6 g/day of meropenem were given. Hearing impairment was recorded in 11 meropenem and nine cephalosporin treated patients. Three patients in the meropenem group and one in the cephalosporin group died during treatment for reasons unrelated to study therapy. Overall, the results of this study indicate that meropenem is an effective and well-tolerated antibiotic for the treatment of bacterial meningitis in adults.

Topics: Adult; Carbapenems; Cefotaxime; Ceftriaxone; Humans; Meningitis, Bacterial; Meropenem; Thienamycins; Treatment Outcome

Four hundred and seventy patients who had undergone neurosurgical operations were studied prospectively. After defining post-operative infection so that is included all the infective complications irrespective of location occurring after surgery, the overall infection rate was 17%. The infection rate in 413 cases without pre-existing infection was 15%. Wound infection was recorded in 5% and meningitis in 6%. Risk factors which lead to a significant increase in the incidence of postoperative infection were found to be altered sensorium, multiple operations, pre-existing infection, emergency surgery, duration of surgery more than 4 hours, urinary catheterisation, cerebrospinal fluid leak, and ventilatory support.

Topics: Administration, Oral; Bacterial Infections; Cefotaxime; Central Nervous System Diseases; Cephalexin; Cerebrospinal Fluid Shunts; Cross Infection; Female; Gentamicins; Humans; Injections, Intramuscular; Male; Meningitis, Bacterial; Middle Aged; Penicillins; Premedication; Prospective Studies; Risk Factors; Surgical Wound Infection

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Female; Finland; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cephalosporins; Humans; Meningitis; Meningitis, Bacterial; Meningitis, Pneumococcal; Microbial Sensitivity Tests

Topics: Cefotaxime; Ceftriaxone; Humans; Meningitis; Meningitis, Bacterial

As daptomycin adjunction is currently under clinical evaluation in the multicentre phase II AddaMAP study to improve the prognosis of pneumococcal meningitis, the present work aimed at evaluating the in vitro antimicrobial activity of daptomycin-based combinations against some of the most frequent species responsible for bacterial meningitis.. Clinically relevant strains of Streptococcus pneumoniae, Listeria monocytogenes, Haemophilus influenzae and Neisseria meningitidis were obtained from National Reference Centers. The antimicrobial activity of amoxicillin, cefotaxime and rifampicin, either alone or in association with daptomycin, was explored through the determination of minimum inhibitory concentration (MIC) and fractional inhibitory concentration index (FICI) as well as time-kill assay (TKA) using the broth microdilution method.. All species taken together, the adjunction of daptomycin had no deleterious impact on the antimicrobial activity of amoxicillin, cefotaxime or rifampicin in vitro. Regarding Gram-positive bacteria, FICI and TKA analysis confirmed a global improvement of growth inhibition and bactericidal activity due to the adjunction of daptomycin. The synergistic effect prevailed for L. monocytogenes as demonstrated by FICI mainly <0.5 and a dynamic TKA-based synergy rate >50%. In addition, daptomycin-based associations did not modify the activity of β-lactam antibiotics or rifampicin against Gram-negative bacteria, notably N. meningitidis.. These results bring comforting evidence towards the clinical potential of daptomycin adjunction in the treatment of bacterial meningitis, which supports the ongoing AddaMAP clinical trial.

Topics: Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Daptomycin; Humans; Meningitis, Bacterial; Rifampin

Group B Streptococcus (GBS) is an important cause of invasive infection in neonates and infants. Cerebrospinal fluid (CSF) findings and culture may not show evidence of infection early in GBS meningitis. Next-generation sequencing (NGS) has the potential to detect microbial genetic material in patients with infectious diseases. We report two cases of infantile sepsis of GBS meningitis with negative results for CSF culture tests, but positive results for NGS analysis.. Patient 1 was a 22-day-old male infant diagnosed with sepsis and meningitis. His CSF findings showed pleocytosis, decreased glucose, and increased protein levels. However, CSF and blood culture results at admission were negative. He received a total of 3 weeks of treatment with ampicillin and cefotaxime, and showed clinical improvement. GBS was detected through NGS analysis of CSF collected at admission. Patient 2 was a 51-day-old male infant with sepsis. CSF findings on admission were normal, and blood and CSF cultures were also negative. Intravenous ampicillin and cefotaxime treatment were initiated. Treatment was de-escalated to ampicillin alone because Enterococcus faecalis was cultured from urine. He was discharged after a total of 1 week of antibiotic treatment. Six days after discharge, he was re-hospitalized for sepsis. Blood and CSF cultures were negative, and E. faecalis was again cultured from urine. He received a total of 3 weeks of ampicillin treatment for enterococcal-induced nephritis and did not relapse thereafter. NGS pathogen searches were retrospectively performed on both blood and CSF collected at the first and second admission. GBS was detected in the CSF collected at the first admission, but no significant pathogen was detected in the other samples. Inadequate treatment for GBS meningitis at the first admission may have caused the recurrence of the disease.. Infantile sepsis may present bacterial meningitis that is not diagnosed by either culture testing or CSF findings. NGS analysis for CSF may be useful for confirming the diagnosis of bacterial meningitis.

Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Cerebrospinal Fluid; Enterococcus faecalis; High-Throughput Nucleotide Sequencing; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Retrospective Studies; Sepsis; Streptococcal Infections; Streptococcus agalactiae; Urine

Bacterial meningitis is a serious inflammation of the meninges. Antimicrobial therapy on early cerebrospinal fluid (CSF) examination has an important role in diagnosis. The disease is still challenging in developing countries because of poor (diagnostic set-up, socioeconomic conditions, management), and misuse of antimicrobial therapy results in emerging antimicrobial-resistant strains. Therefore, this hospital based cross sectional study was aimed to assess the antimicrobial sensitivity profile and bacterial isolates among patients suspected of pyogenic meningitis at Hawassa University Hospital from February 2017 to 2018.. A total of 394 patients suspected as meningitis were included. Of these 210 (53.3%) were males and 184 (46.7%) were females. The carriage rate of bacterial pathogens was 27(6.9%). The common clinical presentations were fever 330 (83.8%), headache 205 (52.0%) and neck stiffness 179(45.4%) followed by altered mental status 125(31.7%). Neck stiffness P = 0.001 (AOR = 1.18, 95% CI 1.06-6.53), Hx of seizure P = 0.043, (AOR = 1.39, 95% CI 1.15-5.99), Nuchal rigidity P = 0.001* (AOR = 1.26, 95% CI 1.06-4.48) were significantly associated with culture positivity. The pathogens isolated in this study were N. meningitidis the most frequent isolate 12(44.4%) followed by S. pneumoniae 5 (18.5%), E. coli 4(14.8%), H. influenza 3(13.6%), S. aureus 2(11.1%) and K. pneumoniae 1(3.7%). S. pneumoniae was (100%) resistance to penicillin, (80%) amoxicillin, and (20%) Cefotaxime. S. aureus was (100%) resistant to penicillin, amoxicillin, and ciprofloxacin. N. meningitidis was (100%) resistant to penicillin, (66.7%) Ceftriaxone and (41.7%) chloramphenicol. In this study a single isolate was also resistant to a different antibiotic.. The prevention of bacterial meningitis needs serious attention since the isolated bacteria showed single and multiple antimicrobial susceptibility patterns and the variable nature of isolated etiological agents makes it reasonable to provide continuous future updates on local resistance of common antibiotics and optimize the most frequent bacteria associated with meningitis in the hospital. Therefore; further, survey study with a better design of antimicrobial susceptibility at large scale to control the spread of antibiotic-resistant bacteria and the change in the causative organism of bacterial meningitis in the study area and at a national level is required.

Topics: Adolescent; Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Bacteria; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Female; Hospitals, University; Humans; Infant; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Middle Aged; Penicillins; Phylogeny; Young Adult

Cefotaxime, alone or with ampicillin, is frequently used in empirical treatment of acute bacterial meningitis (ABM). Meropenem is a less extensively investigated alternative. The aim of the study was to investigate the effects of empirical treatment with meropenem compared to cefotaxime plus ampicillin on outcome in ABM. The study was based on data from the Swedish quality register for ABM collected between January 2008 and December 2016. Propensity score matching was performed to adjust for baseline differences between the groups. Mortality within 30 days was the primary outcome. The treatment regimens of interest were administered to 623 patients; 328 were given cefotaxime plus ampicillin whereas 295 received meropenem. Using propensity score matching, the 30-day mortality rates were 3.2% in the cefotaxime plus ampicillin group and 3.6% in the meropenem group. For matched cases, the odds ratio (OR) for 30-day mortality for meropenem versus cefotaxime plus ampicillin was 1.15 (confidence interval [CI], 0.41 to 3.22;

Topics: Adult; Age Factors; Aged; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Drug Therapy, Combination; Female; Humans; Male; Meningitis, Bacterial; Meropenem; Middle Aged; Propensity Score; Registries; Sweden; Treatment Outcome

Non-typhoid Salmonella (NTS) is an important cause of bacterial meningitis in newborn and infants in developing countries, but rarely in industrialized ones. We describe an unusual presentation of bacterial meningitis in an infant, focusing on his diagnostic and therapeutic management.. An Italian two-month old male presented high fever and diarrhea with blood, associated with irritability. Inflammatory markers were high, cerebrospinal fluid analysis was compatible with bacterial meningitides but microbiological investigations were negative. Salmonella enteritidis was isolated from blood. Cerebral ultrasound and MRI showed periencephalic collection of purulent material. Specific antibiotic therapy with cefotaxime was initiated with improvement of clinical conditions and blood tests. Brain MRI follow up improved progressively.. Most of pediatric patients with NTS infection develop self-limited gastroenteritis, but in 3-8% of the cases complications such as bacteremia and meningitis may occur, especially in weak patients. Cerebral imaging can be useful to identify neurological findings. Although there is no standardized treatment for this condition, specific antibiotic therapy for at least four weeks is recommended. Neuroimaging follow up is required due to high risk of relapse.

Topics: Cefotaxime; Follow-Up Studies; Humans; Infant; Italy; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Rare Diseases; Risk Assessment; Salmonella enteritidis; Salmonella Infections; Tomography, X-Ray Computed; Treatment Outcome

Common etiological agents of neonatal meningitis include group B Streptococcus, Escherichia coli, and Staphylococcus aureus. Here we report a rare pathogen - Streptococcus bovis - causing meningitis in a premature neonate with Down syndrome.. A 26-day-old Asian male neonate with Down syndrome presented with a history of high-grade fever, poor sucking, poor cry, and reduced activity. On admission, he was febrile and had features of circulatory collapse. A cerebrospinal fluid examination confirmed bacterial meningitis and blood culture isolated the causative organism: group D Streptococcus, which was verified as Streptococcus bovis biotype 2. An echocardiogram did not show evidence of infective endocarditis.. This is probably the first report of neonatal meningitis due to Streptococcus bovis in a child with Down syndrome. Although our patient did not show features of overt immunodeficiency, subtle abnormalities in his immune system would have predisposed him to infection with this unusual organism. This case highlights the need for considering unusual pathogens when managing serious infections in children with Down syndrome.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Cefotaxime; Down Syndrome; Humans; Infant, Newborn; Infant, Premature; Male; Meningitis, Bacterial; Penicillin G; Rare Diseases; Streptococcal Infections; Streptococcus bovis

To explore the clinical characteristics and etiology of bacterial meningitis (BM) in Chinese children.. BM cases in children 28days to 18 years old were collected from January 2014-December 2016 and screened according to World Health Organization standards. Clinical features, pathogens, and resistance patterns were analyzed.. Overall, 837 cases were classified into five age groups: 28 days-2 months (17.0%), 3-11 months (27.8%), 12-35 months (24.0%), 3-6 years (13.9%), and >6years (17.3%). Major pathogens were Streptococcus pneumoniae (S. pneumoniae, n=136, 46.9%), group B Streptococcus (GBS, n=29, 10.0%), and Escherichia coli (E. coli, n=23, 7.9%). In infants <3 months old, GBS (46.5%) and E. coli (23.3%) were most common; in children >3 months old, S. pneumoniae (54.7%), which had a penicillin non-susceptibility rate of 55.4% (36/65), was most frequent. The resistance rates of S. pneumoniae and E. coli to cefotaxime and ceftriaxone were 14.0%/40.0% and 11.3%/68.4%, respectively. All GBS isolates were sensitive to penicillin.. The occurrence of BM peaked in the first year of life, while S. pneumoniae was the predominant pathogen in children >3months of old. The antibiotic resistance of S. pneumoniae was a concern.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; China; Drug Resistance, Bacterial; Escherichia coli; Female; Humans; Infant; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Penicillin G; Retrospective Studies; Streptococcus agalactiae; Streptococcus pneumoniae

Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Humans; Meningitis, Bacterial

To analyze the clinical characteristics of blood stream infection caused by Streptococcus agalactiae in children and the drug-resistance of the isolates.. All cases with Streptococcus agalactiae growth in blood or cerebrospinal fluid cultures from January 1, 2011 to December 31, 2015 were enrolled by checking the laboratory information system (LIS) from 7 Class 3 Grade A hospitals (4 in Zhejiang, 2 in Shanghai and 1 in Chongqing). Clinical data were collected for analysis. χ(2) test, t test and non parametric test were used in the study.. One hundred and eighty-one pediatric cases of blood stream infection caused by Streptococcus agalactiae were included in current study. Eighty-six cases (47.5%) were male, and with age range from one day to 9 years (media 13 days). Thirty cases (16.6%) were premature infants and 127 cases (70.2%) were born via vaginal delivery. Seventy-one cases (39.2%) had early onset (<7 d) infections, and 106 cases (58.6%) had late onset (7-89 d) infections. Seventy-eight cases (43.1%) were complicated with purulent meningitis. Incidences of vaginal delivery(81.7%(58/71) vs. 62.3%(66/106)), shortness of breath moaning (43.7%(31/71) vs. 15.1%(16/106)) and preterm premature rupture of membranes (25.4%(18/71) vs. 3.8%(4/106)) were higher in the early onset infection group compared with the late onset group(P all<0.05). However, the number of cases who had fever(25.4%(18/71)vs.85.8%(91/106)) and complicated with purulent meningitis (29.6%(21/71) vs. 53.8%(57/106)) in early onset infections group was less than that in the late onset group(P both<0.05). The blood cultures of most patients (87.8%) were performed before the use of antibiotics. Drug-resistant tests showed that the sensitive rates to penicillin G, ceftriaxone and cefotaxime were 98.9%, 99.0% and 99.0% respectively. All strains were sensitive to vancomucine. The rates of resistance to clindamycin and erythromycin were 68.0% and 34.0%, respectively. Only 39 cases (22.0%) were treated with single antibiotics of either penicillins or cephalosporins, 80 cases (45.2%) were treated with antibiotics containing β lactamase inhibitor, 61 cases (34.5%) were treated with either meropenem or cefoperazone-sulbactam. One hundred and fifty-four cases were cured, while 19 died (including 13 complicated with purulent meningitis) and 8 lost to follow up after giving up of treatment.. The incidence and mortality of blood stream infection caused by Streptococcus agalactiae complicated with purulent meningitis are high in children. Penicillin is the first choice in treatment. Antibiotics should be selected accorrding to the drug-resistance test.

Topics: Anti-Bacterial Agents; Bacteremia; Cefotaxime; Ceftriaxone; Cephalosporins; Child; China; Clindamycin; Drug Resistance, Bacterial; Erythromycin; Female; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Penicillins; Retrospective Studies; Streptococcal Infections; Streptococcus agalactiae

Community-acquired bacterial meningitis due to Klebsiella pneumoniae has mainly been described in Southeast Asia and has a poor prognosis. Severe invasive infections caused by K. pneumoniae, including meningitis, are often due to hypervirulent strains (hvKP), which are characterized by capsular serotypes K1 and K2, a gene responsible for hypermucoviscosity, and the cluster for synthesis of the siderophore aerobactin.. A 55 year old man with a history of essential hypertension, benign prostate hyperplasia, hyperlipidemia, obstructive sleep apnea, and chronic alcoholism was admitted for meningitis due to Klebsiella pneumoniae with a wild-type susceptibility profile. Its genomic features were consistent with a capsular K2 strain belonging to clonal group 86 (CG86) displaying the large virulence of Klebsiella plasmid (pLVPK) with heavy metal resistance gene clusters, aerobactin, rmpA.. This is the first case of community-acquired meningitis caused by a hypervirulent strain of hvKP ever reported in the Caribbean.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Cefotaxime; Community-Acquired Infections; Genotype; Guadeloupe; Humans; Hydroxamic Acids; Klebsiella Infections; Klebsiella pneumoniae; Male; Meningitis, Bacterial; Middle Aged; Plasmids; Serogroup; Virulence Factors

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Female; Humans; Meningitis, Bacterial; Obesity

To study the clinical characteristics, pathogenic bacteria, and antibiotics resistance of neonatal purulent meningitis in order to provide the guide for early diagnosis and appropriate treatment.. A retrospective review was performed and a total of 112 cases of neonatal purulent meningitis (male 64, female 58) were identified in the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical University seen from January 1, 2004 to December 31, 2013. The clinical information including pathogenic bacterial distribution, drug sensitivity, head imageology and therapeutic outcome were analyzed. Numeration data were shown in ratio and chi square test was applied for group comparison.. Among 112 cases, 46 were admitted from 2004 to 2008 and 66 from 2009 to 2013, 23 patients were preterm and 89 were term, 20 were early onset (occurring within 3 days of life) and 92 were late onset meningitis (occurring after 3 days of life). In 62 (55.4%) cases the pathogens were Gram-positive bacteria and in 50 (44.6%) were Gram-negative bacteria. The five most frequently isolated pathogens were Escherichia coli (32 cases, 28.6%), coagulase-negative staphylococcus (CNS, 20 cases, 17.9%), Streptococcus (18 cases, 16.1%, Streptococcus agalactiae 15 cases), Enterococci (13 cases, 11.6%), Staphylococcus aureus (9 cases, 8.0%). Comparison of pathogenic bacterial distribution between 2004-2008 and 2009-2013 showed that Gram-positive bacteria accounted for more than 50% in both period. Escherichia coli was the most common bacterium, followed by Streptococcus in last five years which was higher than the first five years (22.7% (15/66) vs. 6.5% (3/46), χ(2) = 5.278, P < 0.05). Klebsiella pneumoniae was more common isolate in preterm infants than in term infants (13.0% (3/23) vs. 1.1% (1/89), χ(2) = 7.540, P < 0.05). Streptococcus (most were Streptococcus agalactiae) was the most common bacteria in early onset meningitis and higher than those in late onset meningitis (35.0% (7/20) vs. 12.0% (11/92), χ(2) = 4.872, P < 0.05). Drug sensitivity tests showed that all the Gram-positive bacterial isolates were sensitive to linezolid. Staphylococci were resistant to penicillin, and most of them were resistant to erythromycin, oxacillin and cefazolin; 77.8%of CNS isolates were methicillin-resistant staphylococcus. No Streptococcus and Enterococcus faecalis was resistant to penicillin. None of enterococci was resistant to vancomycin. Among the Gram-negative bacterial isolates, more than 40% of Escherichia coli were resistant to commonly used cephalosporins such as cefuroxime, cefotaxime and ceftazidime, and all of them were sensitive to amikacin, cefoperazone sulbactam and imipenem. Isolates of Klebsiella pneumoniae were all resistant to ampicillin, cefuroxime, cefotaxime and ceftazidime, but none of them was resistant to piperacillin tazobactam and imipenem. Of the 112 patients, 69 were cured, 23 improved, 9 uncured and 11 died. There were 47 cases (42.0%) with poor prognosis, they had abnormal head imageology, severe complications and some cases died, 13 of 18 (72.2%) patients with meningitis caused by Streptococcus died.. Escherichia coli, CNS and Streptococcus are the predominant pathogens responsible for neonatal purulent meningitis over the past ten years. There were increasing numbers of cases with Streptococcus meningitis which are more common in early onset meningitis with adverse outcome, therefore careful attention should be paid in clinic. Linezolid should be used as a new choice in intractable neonatal purulent meningitis cases caused by gram positive bacteria.

Topics: Anti-Bacterial Agents; Cefotaxime; Child; Drug Resistance, Bacterial; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Imipenem; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Male; Meningitis, Bacterial; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Penicillins; Retrospective Studies; Staphylococcus; Staphylococcus aureus; Streptococcal Infections; Streptococcus; Streptococcus agalactiae

Community-acquired meningitis is a monomicrobial infection caused by either viruses or bacteria in the vast majority of patients. We report here one exceptional case of a patient with mixed bacterial meningitis due to Streptococcus pneumoniae and Streptococcus pyogenes.. We report the case of a 68-year-old immunocompromised Caucasian man suffering from otitis and then meningitis caused by Streptococcus pneumoniae and Streptococcus pyogenes. Bacteria were undistinguishable by direct microscopic examination of the cerebrospinal fluid. He responded well to treatment with cefotaxime and dexamethasone, with no sequelae observed at the 4-month follow-up.. This first reported case of mixed S. pneumoniae and S. pyogenes meningitis illustrates the life-threatening consequences of barotrauma in immunocompromised patients suffering from otorhinolaryngeal infections.

Topics: Aged; Anti-Bacterial Agents; Cefotaxime; Coinfection; Dexamethasone; Humans; Immunocompromised Host; Male; Meningitis, Bacterial; Streptococcus pneumoniae; Streptococcus pyogenes

Streptococcus pyogenes is a rare but aggressive cause of meningitis, which often evolves in a poor outcome with fatal consequences. Although lumbar puncture and CT scan of the brain are the gold standard of diagnosis of cerebral infections, they can have some limitations. We report and describe the clinical history and neuroimaging of a 36-year-old woman admitted to the emergency department of our hospital three days after the onset of earache and otorrhoea. When the patient developed an emergent refractory status epilepticus, the CT scan of the brain showed an unusual pneumocephalus. However, the MRI study of the brain revealed a pachymeningitis with partial thrombosis of the right transverse sinus and subdural empyema due to a S. pyogenes otitis media. Prompt diagnosis and the specific findings of the MRI allowed rapid correct treatment and thus led to a good outcome for the patient.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Diagnosis, Differential; Drug Therapy, Combination; Empyema, Subdural; Female; Humans; Magnetic Resonance Imaging; Meningitis, Bacterial; Otitis Media; Pneumocephalus; Severity of Illness Index; Status Epilepticus; Streptococcus pyogenes; Tomography, X-Ray Computed; Treatment Outcome

To determine the common aetiolog of acute bacterial meningitis in children and their antibiotic susceptibility pattern.. A retrospective study with a review of cerebrospinal fluid culture reports of paediatric patients aged 0-15 years, suspected of acute meningitis in the Medical Microbiology Department of Aminu Kano Teaching Hospital, Kano, Nigeria from October 2006 to October 2009 from October 2006 to October 2009.. A positive culture bacterial isolation rate of 3.3% (n=50/1500) with prevalence of Streptococcus pneumoniae (24%), Neisseria meningitidis (22%), Escherichia coli (16%), Haemophilus influenzae (14%), Group B streptococci (8%) and Enterococci (8%) which were susceptible to ceftriaxone (96%), cefotaxime (95%) and ciprofloxacin (93%) across the bacterial isolates. Neonates were 55% (n=6.8/12.4) most at risk.. Neonates are the most at risk of acute bacterial meningitis. In the absence of antibiotic susceptibility report, ceftriaxone should be considered as a first choice reliable antibiotic for empirical treatment of meningitis in children, in this environment.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cerebrospinal Fluid; Child; Child, Preschool; Ciprofloxacin; Enterococcus; Escherichia coli; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Meningitis, Escherichia coli; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Nigeria; Retrospective Studies; Streptococcus agalactiae; Tertiary Care Centers

We had for aim to check the appropriateness of our practices according to French guidelines (17th consensus conference, SPILF 2008) and to identify variables associated with the delay before appropriate measures were implemented.. Our retrospective observational study (2009-2011) focused on acute bacterial meningitis (ABM) in adults. Data was collected on a standardized questionnaire from medical charts and nurse reports.. We included 31 adults presenting with ABM; 29 (93.5%) received ceftriaxone or cefotaxime in the emergency department. Indications for corticosteroids and brain imaging complied with guidelines in respectively 71.0% and 83.9% of cases. The median delays (IQR) were: admission/lumbar puncture (LP), 2h43 [1h09-5h57]; admission/antimicrobials, 3h21 [1h34-5h11]. The indication of suspected ABM in the admission letter was associated with earlier LP (P=0.01), and was almost significantly associated also with faster initiation of adequate antibiotic therapy (P=0.05).. Suspicion of ABM mentioned in the admission letter was associated to a better management in the emergency department.

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Delayed Diagnosis; Disease Management; Emergency Service, Hospital; Female; Guideline Adherence; Humans; Male; Meningitis, Bacterial; Middle Aged; Practice Guidelines as Topic; Retrospective Studies; Risk Factors; Spinal Puncture

'Leptotrichia amnionii' is an underestimated fastidious inhabitant of the vaginal flora that can cause upper genital tract infections when predisposing factors are present. We describe here what is believed to be the first reported case of early onset meningitis due to 'L. amnionii' in a neonate with intrauterine growth retardation. The outcome was favourable after cefotaxime treatment.

Topics: Anti-Bacterial Agents; Cefotaxime; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Fetal Growth Retardation; Fusobacteriaceae Infections; Humans; Infant, Newborn; Leptotrichia; Meningitis, Bacterial; Molecular Sequence Data; Netilmicin; Pregnancy; Pregnancy Complications, Infectious; Young Adult

Topics: Acetaminophen; Anti-Infective Agents; Antipyretics; Cefotaxime; Female; Gram-Positive Bacteria; Humans; Male; Meningitis, Bacterial

Topics: Alcoholism; Cefotaxime; Communicable Diseases, Emerging; Disease Susceptibility; Drug Resistance, Multiple, Bacterial; Environmental Exposure; Humans; Immunocompromised Host; Male; Meningitis, Bacterial; Middle Aged; Rural Health; Spain; Streptococcal Infections; Streptococcus suis

Topics: Acetaminophen; Anti-Infective Agents; Antipyretics; Cefotaxime; Female; Gram-Positive Bacteria; Humans; Male; Meningitis, Bacterial

An evaluation committee studied the relationship between initial treatment drug and prognosis in 339 of 466 subjects with bacterial meningitis treated at 108 institutions between April 2004 and January 2007, after excluding those with uncertain diagnosis or non-assessable records. Prognosis was considered unfavorable if meningitis sequelae such as quadriplegia, deafness, or epilepsy were present in 3- month follow-up; Based on this definition, 43 (12.7%) had a poor prognosis. No significant relationship was seen between unfavorable prognosis and age or causative pathogen. More had an unfavorable prognosis if treatment was initiated 4 days or later after onset. The percentage with an unfavorable prognosis was 6.4% (4/64) in the group administered combined panipenem/betamipron (PAPM/BP) plus ceftriaxone (CTRX), 10.5% (6/57) administered MEPM plus cefotaxime (CTX), 14.0% (7/50) administered meropenem (MEPM) plus CTRX, and none of the 23 administered CTRX alone. The percentage with an unfavorable prognosis was 26.2% (11/42) in those administered MEPM, significantly higher than that in those administered PAPM/BP plus CTRX, MEPM plus CTX, or CTRX alone (p < 0.05). We concluded that in initial treatment, it would be more desirable to use MEPM combined with another drug than alone.

Topics: Anti-Bacterial Agents; beta-Alanine; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Therapy, Combination; Humans; Infant; Meningitis, Bacterial; Meropenem; Prognosis; Thienamycins

Food effects were defined as positive, when coadministration of food causes an increase in the extent of absorption (AUC(0-∞)) of a drug when compared with fasted state drug administration and no effect when coadministration of food causes no change in AUC(0-∞). In general, low solubility drugs exhibit positive food effects due to improved solubility in fed state administration. But, certain high-solubility and high-permeability drugs that undergo extensive presystemic metabolism exhibit positive food effects because of the increased splanchnic hepatic blood flow in the fed state presumably causing a fraction of drug to bypass first-pass metabolism during absorption.. In this study, systemic clearance (Cl) of structurally diverse high-permeability and high-solubility drugs was correlated to their food effects to explore whether drugs undergoing low clearance exhibited no food effects and drugs undergoing high clearance exhibited positive food effects.. Six drugs exhibiting positive food effects and nine drugs exhibiting no food effects (for comparison) were selected for linear regression analysis.. Regression analysis of the selected drugs indicated that percent food effects correlated linearly to Cl and fitted the equation: percent food effects = 0.9163 × Cl - 6.4789. The R(2), p-value and power of the regression model were >0.88, 0.9999, respectively indicating the direct correlation between Cl and food effects of the selected model drugs; other statistical tests validated the model.. The model indicated that high-solubility and high-permeability drugs undergoing Cl of more than 27 L/h may exhibit statistically significant positive food effects.

Topics: Administration, Intranasal; Animals; Anti-Bacterial Agents; Area Under Curve; Biological Availability; Brain; Cattle; Cefotaxime; Food-Drug Interactions; Humans; Male; Meningitis, Bacterial; Rats; Rats, Sprague-Dawley

Topics: Anti-Bacterial Agents; Antidiuretic Agents; Cefotaxime; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Drug Therapy, Combination; Gentamicins; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

We report the first case of acute meningitis caused by a rare, atypical pathogen. An 11-month-old infant was admitted to hospital with clinical symptoms typical of acute meningitis. Cerebrospinal fluid analysis revealed an elevated neutrophil cell count and high proteins. Microbiological examination of the fluid confirmed an atypical cause of meningitis--Staphylococcus intermedius. Antibiotic therapy with cefotaxime was successful and the child made a full recovery.

Topics: Acute Disease; Anti-Bacterial Agents; Cefotaxime; Humans; Infant; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Staphylococcal Infections; Staphylococcus intermedius

Globicatella sanguinis is a rare cause of acute meningitis. We demonstrated human carriage of Globicatella by identifying cefotaxime-resistant strains in groin and rectal specimens 9 months after invasive infection. The pathogenic strain isolated from the cerebrospinal fluid and the carriage strains were accurately identified by sodA gene sequence analysis.

Topics: Aerococcaceae; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Typing Techniques; beta-Lactam Resistance; Carrier State; Cefotaxime; Cerebrospinal Fluid; DNA, Bacterial; Female; Genotype; Gram-Positive Bacterial Infections; Groin; Humans; Meningitis, Bacterial; Middle Aged; Molecular Sequence Data; Rectum; Sequence Analysis, DNA; Superoxide Dismutase

Sinusitis can rarely be latent and present directly with intracranial complications. We present the case of an 11-year-old girl who presented with typical features of meningitis. She underwent neuroimaging because of slow improvement and concern for a brain abscess. Despite no history or examination findings suggestive of sinusitis, she was found to have pansinusitis with intracranial extension causing meningitis and epidural abscess.

Topics: Bacteroidaceae Infections; Cefotaxime; Ceftriaxone; Child; Combined Modality Therapy; Consciousness Disorders; Diagnostic Imaging; Drug Therapy, Combination; Eikenella; Emergencies; Endoscopy; Epidural Abscess; Female; Fusobacterium Infections; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Meningitis, Bacterial; Metronidazole; Otorhinolaryngologic Surgical Procedures; Peptostreptococcus; Prevotella intermedia; Sinusitis; Staphylococcal Infections; Vancomycin

* Young infants who have meningitis may present with nonspecific clinical manifestations. * S. pneumoniae and N. meningitidis remain the most common causes of bacterial meningitis in the infant and child, and GBS continues to be the most common neonatal pathogen. * Empiric therapy for suspected bacterial meningitis in a non-neonate includes a combination of parenteral vancomycin and either cefotaxime or ceftriaxone. * Children whose GCS scores are less than 8, show signs of shock or respiratory compromise, and have focal neurologic findings or clinical signs of elevated intracranial pressure should be admitted to a pediatric intensive care unit. * Sensorineural hearing loss occurs in 30% of children who have pneumococcal and 10% of those who have meningococcal meningitis.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Drug Therapy, Combination; Hearing Loss; Humans; Incidence; Infant; Intracranial Hypertension; Meningitis; Meningitis, Bacterial; Meningitis, Meningococcal; Vancomycin

Salmonella meningitis is an unusual complication of Salmonella sepsis and occurs mainly in children. A rare case of Salmonella typhimurium meningitis occurring in an adult HIV positive man who presented with a history of fever and diarrhoea is reported. On examination he was dehydrated, and had oral thrush, weakness of lower limbs and neck stiffness. A septic diagnostic screen was performed and he was commenced on empiric intravenous cefotaxime therapy for meningitis. S typhimurium was cultured from cerebrospinal fluid and blood culture specimens. It was non-lactose fermenting, oxidase negative, H(2)S positive and motile. Cefotaxime was continued for 14 days and the patient responded without neurological sequelae.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Cefotaxime; Humans; Male; Meningitis, Bacterial; Salmonella Infections; Salmonella typhimurium

Risk factors, therapy and outcome of 15 cases of nosocomial meningitis due to Pseudomonas aeruginosa is reviewed. No difference in risk factors was found, however mortality for Ps. aeruginosa was significantly higher (33.3 vs 15.1% p<0.04).

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Chi-Square Distribution; Child, Preschool; Chloramphenicol; Cross Infection; Drug Therapy, Combination; Female; Gentamicins; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Meropenem; Pseudomonas Infections; Retrospective Studies; Risk Factors; Survival Analysis; Thienamycins

Streptococcus pneumoniae is actually the first most likely organism to cause meningitis in children 2 months to 2 years old and in adults older than 65 years. From January 1990 to December 2005, 72 cases of S. pneumoniae-positive cerebrospinal fluid culture were indexed in our hospital. Among the 72 cases, 25 came from children, and 60% of these came from children under two years of age and 47 came from adults whose the mean age was 55 years. The first penicillin-resistant S. pneumoniae (PNSP) meningitis was identified in 1993. The susceptibility to penicillin of pneumococcal isolates causing meningitis varied according to time; until 1995, 25% of the strains were PNSP, then from 1996 to 2005, 50% of strains were PNSP. The overall prevalence of non-susceptible was 34.7% (25/72). Among the 25 PNSP, 21 were intermediate to penicillin G and four of them were resistant. Among children, seven PNSP meningitis were indexed and one of them was resistant. The antimicrobial MICs of amoxicillin and cefotaxim varied from 0.064 to 1 mg/l and from 0.016 to 0.5 mg/l respectively. Among adults, 18 PNSP meningitis were indexed. Three strains were penicillin-resistant. The antimicrobial MICs of amoxicillin varied from 0.064 to 2 mg/l. Nine strains of 18 PNSP had cefotaxim MIC>/=0.5 mg/l and, four of them had MIC 1 mg/l. None amoxicillin and cefotaxim-resistant strain was isolated. Serotyping of all strains was performed in the Reference Center. Serotypes 6B, 9V and 19 were the most frequent in child and serotypes 6B, 23F, 19, 9, 4 were the most frequent in adult. So, all serotypes were represented.

Topics: Adolescent; Adult; Aged; Amoxicillin; Cefotaxime; Child; Child, Preschool; France; Humans; Incidence; Meningitis, Bacterial; Microbial Sensitivity Tests; Middle Aged; Penicillin G; Penicillin Resistance; Pneumococcal Infections; Streptococcus pneumoniae

Our objective is to determine in vitro efficiency of moxifloxacin (MXF) alone or in combination with cefotaxime (CTX) on Group B streptococcus (GBS).. For 21 strains of GBS isolated from newborn invasive infections (6 meningitis and 15 bacteraemia), the bacterial growth in Mueller Hinton broth with MXF and/or CTX leaded to the determination of MIC and MBC, the determination of tolerance for CTX and the evaluation of the bacteriostatic action of these antibiotics combination by calculating the FIC index. Time-kill studies were conducted for MXF and CTX alone or in combination for the first four hours, with concentrations likely reached in CSF.. Study of GBS growth with crossed concentrations of MXF and CTX showed no resistant strains, no tolerant strains, and no antagonism between MXF and CTX. Killing curves demonstrated that MXF is ten-fold more active than CTX in the first four hours.. MXF is an interesting antibiotic for its good activity on the GBS, suggesting that MXF is a good candidate for further evaluation in GBS meningitis in animal model.

Topics: Anti-Bacterial Agents; Aza Compounds; Bacteremia; Cefotaxime; Drug Therapy, Combination; Fluoroquinolones; Humans; Infant, Newborn; Meningitis, Bacterial; Microbial Sensitivity Tests; Moxifloxacin; Quinolines; Serotyping; Streptococcal Infections; Streptococcus agalactiae

Str. pneumoniae isolates were susceptible to penicillin, all to also ofloxacin and chloramphenicol and cefotaxim and 39 (100%) to cotrimoxazol. Concerning S. aureus, all isolates 22 were susceptible to oxacillin and chloramphenicol, and 21 also to cotrimoxazol. All N. meningitidis isolates but one-10 of all were susceptible to penicillin, all to cefotaxim, chloramphenicol and cotrimoxazol. All H.influenzae isolates were susceptible to ampicillin and chloramphenicol, as well as to ofloxacin and cotrimoxazol. Those surprisingly high susceptibilities to rather "old" antibiotics may be explained by low antibiotic consumption, accessibility and therefore low usage which is a key promoter of resistance both in community and hospital.

Topics: Anti-Bacterial Agents; Cefotaxime; Chloramphenicol; Drug Resistance, Microbial; Haemophilus Infections; Haemophilus influenzae; Humans; Meningitis, Bacterial; Microbial Sensitivity Tests; Neisseria meningitidis; Ofloxacin; Penicillins; Staphylococcal Infections; Staphylococcus aureus; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Listeria monocytogenes is not a rare pathogen causing meningitis, mainly in small children and in close contacts to livestock. The pathogen is naturally resistant to cephalosporins and some glycopeptides as well, therefore despite of syndromologic diagnosis of meningitis and initial therapy with 3rd generation cephalosporins according to the guidelines therapeutic failures with clinical consequences may occur.

Topics: Adult; Aged; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Drug Resistance, Bacterial; Female; Humans; Listeriosis; Male; Meningitis, Bacterial; Middle Aged; Outcome Assessment, Health Care

Community acquired bacterial (CBM) meningitis in diabetic patients was analyzed for risk factors and outcome in a cohort of 201 cases of meningitis within last 17 years: 15 patients with diabetes mellitus and meningitis were identified and compared for etiology and mortality as well as for neurologic sequellae with all CBM cases.

Topics: Anti-Bacterial Agents; Cefotaxime; Cohort Studies; Community-Acquired Infections; Diabetes Complications; Diabetes Mellitus; Humans; Meningitis, Bacterial; Outcome Assessment, Health Care; Risk Factors; Vancomycin

A 29-year-old woman, who was diagnosed as Crouzon syndrome for which two cranio-facial surgeries had been performed as a child and at the age of 19, developed high fever, headache, and confusion for two days. She was admitted to our hospital. She was diagnosed as bacterial meningitis by cerebrospinal fluid examinations, and her condition was immediately improved by antibiotics. At the age of 23, she also suffered from bacterial meningitis caused by otitis media and sinusitis, and recovered by antibiotics with no sequela. Her cranial computed tomography showed sphenoid and ethmoid sinusitis, and bone deformation and hypertrophy with no fistula connecting intracranial space and sinus. Dead space by cranio-facial surgeries might cause the development of chronic or recurrent sinusitis leading to bacterial meningitis. Our patient is the second case of recurrent bacterial meningitis with Crouzon syndrome to our knowledge. We should recognize that recurrent sinusitis with Crouzon syndrome after cranio-facial surgery is a risk of recurrent meningitis.

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Craniofacial Dysostosis; Drug Therapy, Combination; Ethmoid Sinusitis; Female; Humans; Meningitis, Bacterial; Piperacillin; Plastic Surgery Procedures; Postoperative Complications; Recurrence; Treatment Outcome

A preterm infant with early onset Morganella morganii sepsis was treated with cefotaxime and gentamicin after confirmation of antimicrobial susceptibility. The infant developed persistent ventriculitis caused by the emergence of a cefotaxime-resistant Morganella variant with derepression of its AmpC beta-lactamase. When choosing antibiotic therapy, the risk of development of resistance to cephalosporins should be considered in infections caused by M. morganii and other Gram-negative organisms with inducible AmpC beta-lactamases.

Topics: Bacteremia; Bacterial Proteins; beta-Lactamases; Cefotaxime; Cephalosporin Resistance; Enterobacteriaceae Infections; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Meningitis, Bacterial; Microbial Sensitivity Tests; Morganella morganii

To determine the probability of meropenem (Merrem, AstraZeneca Pharmaceuticals L.P., Wilmington, DE, USA) and cefotaxime (Claforan, Aventis Pharmaceuticals Inc., Bridgewater, NJ, USA) achieving bactericidal exposures in the cerebrospinal fluid against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae.. A 5,000-patient Monte Carlo simulation in a population of 10-year-old children with meningitis was conducted. Pediatric pharmacokinetic data were derived from the literature. Pathogen minimum inhibitory concentrations (MICs) were obtained from common bacteria that had caused meningitis collected during pediatric clinical trials. Time above the MIC exposures in the cerebrospinal fluid was calculated. Bactericidal exposure or probability of target attainment was defined as 40% and 50% time above the MIC for meropenem and cefotaxime, respectively. High cumulative fractions of responses were defined as >90% probability of target attainment against the populations of bacteria.. Meropenem was calculated to achieve 94.7%, 94.3%, and 96.1% cumulative fractions of response against S. pneumoniae, H. influenzae, and N. meningitidis, respectively. Cefotaxime only achieved a high likelihood of bactericidal attainment against N. meningitidis (91.6%). Against S. pneumoniae and H. influenzae, cefotaxime was only calculated to achieve 84.3% and 84.8% cumulative fractions of response, respectively.. In a simulated population of 10-year-old children, meropenem had a high likelihood of attaining bactericidal exposures in the cerebrospinal fluid. Cefotaxime had a >90% cumulative fraction of response against only N. meningitidis. Therefore, at the doses simulated, meropenem may be a more appropriate empiric choice for the treatment of bacterial meningitis in pediatric patients presumed to be caused by these pathogens until culture and susceptibility data are available.

Topics: Anti-Bacterial Agents; Body Weight; Cefotaxime; Child; Computer Simulation; Dose-Response Relationship, Drug; Humans; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Meropenem; Monte Carlo Method; Thienamycins

Topics: Anti-Bacterial Agents; Cefotaxime; Female; Humans; Infant; Meningitis, Bacterial; Recurrence; Salmonella enteritidis; Salmonella Infections

Medication errors may produce severe toxicity resulting in hospitalization. This can be compounded if the physician obtains the wrong concentration from a reference manual and a pharmacy miscalculates the conversion. We report a child presenting with ileus, hypothermia and lethargy after receiving supratherapeutic dosing of phenytoin after a concentration miscalculation.. A one-month-old infant presented to the Emergency Department with progressive worsening of abdominal distension, diminished activity, and a one day history of difficulty feeding secondary to a decreased level of consciousness. The past medical history was significant for neonatal Group B Strep meningitis with seizures. Among the child's discharge medications was a prescription for phenytoin (30 mg/5 mL) 2.5 cc by mouth three times daily. On exam, the child was hypothermic with pink mottled skin, poor responsiveness, prolonged capillary refill, abdominal distension with hypoactive bowel sounds, and a dysconjugate gaze. The Initial phenytoin serum concentration was 91.8 mcg/mL. She was admitted to the PICU and was started on ampicillin and cefotaxime for R/O sepsis. Phenytoin was withheld and subsequent serum concentrations revealed an extremely slow elimination (mcg/mL vs. time pair coordinates were 78.2/13.3h; 74.3/62.3h; 43.7/109.6h; 10.8/160.9h) reflecting zero-order kinetics. Post discontinuing antibiotics, phenytoin levels decreased at rates expected. She was discharged after resolution of symptoms. The MD who had written the phenytoin prescription had based it on the Harriet Lane Handbook, 2000 Ed. The 30 mg/5 mL formulation has been unavailable in the US for several years. A community pharmacy substituted the 125 mg/5 mL formulation, but miscalculated the dosage to be 1.6 cc (40 mg) tid.. Abdominal distension and ileus may be presenting symptoms in children at toxic phenytoin levels. Ampicillin and cefotaxime may effect the elimination rate of phenytoin at such levels. We report one of the highest phenytoin levels recorded after therapeutic misadventure. Physicians must be aware of inaccuracies in reference manuals that may result in dosing errors.

Topics: Abdomen; Administration, Oral; Ampicillin; Anti-Bacterial Agents; Anticonvulsants; Cefotaxime; Drug Interactions; Drug Overdose; Female; Humans; Ileus; Infant, Newborn; Medication Errors; Meningitis, Bacterial; Phenytoin; Seizures

A retrospective study was conducted on 28 patients with bacterial meningitis who were admitted to our department between April 1988 and March 2002. The most commonly detected pathogen was group B Streptococcus in those under 1 month of age and Haemophilus influenzae (72.2%) among those over 1 month. The most commonly administered antibiotic combination (67.9%) at the initial treatment was that of cefotaxime (CTX) and ampicillin (ABPC). We encountered one case that was resistant to both CTX and ABPC. Through this experience, it became apparent that for the initial treatment of bacterial meningitis in infants, it is necessary to apply a combination of two antibiotics, instead of a single agent, and new antibiotics should be considered for such combinations rather than persisting on conventional CTX and ABPC. The aforementioned 28 patients were divided into 2 groups--7 patients (25.0%) with sequelae and 21 (75.0%) without--and various factors noted during the diagnosis were evaluated retrospectively. It was found that the number of days leading to admission at the hospital and the development of convulsions were unrelated to the prognosis. Those who succumbed or suffered sequelae were all infants under 1 year of age. All cases were caused by genus Haemophilus.

Topics: Ampicillin; Cefotaxime; Drug Therapy, Combination; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Retrospective Studies; Streptococcus agalactiae

Topics: Adult; Algorithms; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Humans; Meningitis, Bacterial; Practice Guidelines as Topic

Comamonas testosteroni, a lesser-known member of the genus, has shown little apparent capacity for causing infections in humans. We here present a case of purulent meningitis due to C. testosteroni, which occurred in a patient who had recurrent cholesteatoma. Ceftriaxone treatment was not effective in this patient even though in vitro the bacteria were susceptible to the drug. The patient responded well to meropenem therapy.

Topics: Anti-Bacterial Agents; Cefotaxime; Cholesteatoma; Comamonas testosteroni; Gram-Negative Bacterial Infections; Humans; Male; Meningitis, Bacterial; Meropenem; Middle Aged; Thienamycins

We present a case of nonbullous impetigo neonatorum associated with late onset group B streptococcal meningitis in a 12-day-old infant. Both skin lesions and meningitis resolved with antibiotic therapy. This is the first reported case of meningitis during the course of this skin disease.

Topics: Anti-Bacterial Agents; Cefotaxime; Humans; Impetigo; Infant, Newborn; Male; Meningitis, Bacterial; Streptococcal Infections

Two major outbreaks of meningitis due Neisseria meningitidis serogroup A occurred in Senegal in 1998 and 1999. The purpose of this report is to describe clinical, bacteriological and therapeutic findings in 70 patients admitted for cerebrospinal meningitis to the Infectious Disease Clinic at the Fann University Teaching Hospital in Dakar in 1999. Diagnosis was based on direct microscopic examination after Gram staining in 71% of the cases, culture in 76%, and detection of soluble antigens in cerebrospinal fluid in 24%. Median patient age was 20 years. The highest incidence, i.e. 66% of cases, was recorded during February, March and April. Meningitic syndrome and fever were observed with 86% of the cases. The average duration of antibiotic therapy was 8 days. Chloramphenicol was the most commonly used drug (84% of cases). All strains identified in cultures were sensitive to chloramphenicol, ceftriaxone and cefotaxime but resistant to cotrimoxazole. Outcome was favorable in 93% of the cases. Three patients (4%) died and two (3%) developed hearing loss. Despite the low death rate in this series of patients treated in a hospital setting, mass vaccination is still the most effective mean of controlling meningococcal meningitis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Female; Haemophilus influenzae; Humans; Infant; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Middle Aged; Neisseria meningitidis; Senegal; Streptococcus pneumoniae; Survival Rate

Topics: Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Citrobacter koseri; Enterobacteriaceae Infections; Gentamicins; Humans; Infant, Newborn; Lung Abscess; Male; Meningitis, Bacterial; Pneumonia, Bacterial

The combination of cefotaxime and fosfomycin (CTX-FOS) has been proposed in France for the empirical treatment of postoperative nosocomial meningitis since the late 1980s. The purpose of this work was to evaluate this strategy today, as well as other possible treatments.. Each patient undergoing a neurosurgical procedure was prospectively included in a database designed for the surveillance of surgical site infection (SSI). For each meningitis detected, we analysed the in vitro susceptibility of the causative micro-organisms to cefotaxime alone (CTX), cefotaxime-fosfomycin (CTX-FOS), vancomycin (VAN) and cefotaxime-vancomycin (CTX-VAN) combinations. The patient population was divided into two groups according to the presence or absence of CSF shunting material.. 116 patients had had a postoperative meningitis/ventriculitis during the last 36 months, among 6447 patients undergoing neurosurgery in our department (1.8%). Ten patients had aseptic meningitis (8.6%). Overall sensitivity to CTX was 69.8%, as compared to 77.3% with CTX-FOS combination (NS). This result was due to a large proportion of fosfomycin resistant cocci in our population. The CTX-VAN combination increased the overall in vitro susceptibility up to 91.5%, but the benefit of this combination was only significant in CSF shunting material patients. In these latter patients, VAN was as effective as CTX-FOS combination.. CTX-FOS combination is no longer the best choice for empirical treatment of post neurosurgical meningitis. CTX alone can be safely used in patients without a CSF shunt; in those with either a ventriculostomy or a CSF shunt associated ventriculitis, a CTX-VAN combination could improve treatment efficacy, provided that high doses of vancomycin are used to ensure correct CSF diffusion.

Topics: Adult; Aged; Cefotaxime; Central Nervous System Diseases; Cerebrospinal Fluid Shunts; Craniotomy; Cross Infection; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Fosfomycin; Humans; Male; Meningitis, Aseptic; Meningitis, Bacterial; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome; Vancomycin

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Humans; Male; Meningitis, Bacterial; Streptococcus pyogenes; Substance Abuse, Intravenous

Data on the incidence of Enterobacter infections in neonates over prolonged periods of time are scant. We determined the epidemiology of Enterobacter sepsis and/or meningitis and the trends of infection in a neonatal unit.. Retrospective review of sepsis and/or meningitis in inborn neonates admitted to Son Dureta University Hospital during a 22-year period. Molecular study by ribotyping of the Enterobacter strains isolated from 1995 to 1997.. There were 513 cases of culture-proved sepsis and/or meningitis in neonates. In late onset infections Klebsiella pneumoniae and Staphylococcus epidermidis were the most frequent isolates in the period 1977 through 1991. Enterobacter was the most common isolate in the period 1992 through 1998. During this latter period Candida infections also increased, and the resistance rate of Enterobacter to cefotaxime was higher (59.2%). Decrease in early onset infections and increase in late onsets (4.6/1,000 live births) were observed in the second period. From 1977 to 1998, 45 episodes of sepsis and/or meningitis by Enterobacter species were identified in 44 patients (8.7% of all neonatal bacteremias). Three patients with Enterobacter bacteremia died (6.6%, 0.03/1,000 live births). During 1995 through 1997 5 different clones causing sepsis were identified and 3 were predominant. In 1997 there was an outbreak of Enterobacter disease. After cleaning, cohort nursing and hygiene reinforcement, Enterobacter was not isolated in the next 2 years. No change in the antibiotic policy was made.. We observed a resurgence of Enterobacter infections in our neonatal intensive care unit. The sudden disappearance of this microorganism after reinforcement of hygienic measures, without withdrawing cefotaxime, confirms the importance of patient-to-patient transmission of this nosocomial infection. Further studies are needed to establish the role of antibiotics in the emergence of microorganisms in neonatal intensive care units.

Topics: Cefotaxime; Cross Infection; Drug Resistance, Bacterial; Enterobacter; Enterobacteriaceae Infections; Female; Humans; Hygiene; Infant, Newborn; Intensive Care Units, Neonatal; Longitudinal Studies; Male; Meningitis, Bacterial; Retrospective Studies; Ribotyping; Sepsis

We describe a case of non-serogroup O:1 Vibrio cholerae bacteremia and cerebritis in a 41-year-old Thai man with alcoholism who presented with fever and cellulitis of the right ankle. He was successfully treated with parenteral cefotaxime and then was switched to treatment with oral ciprofloxacin.

Topics: Adult; Anti-Infective Agents; Bacteremia; Cefotaxime; Cephalosporins; Cholera; Ciprofloxacin; Humans; Male; Meningitis, Bacterial; Vibrio cholerae

Topics: Anti-Bacterial Agents; Cefotaxime; Child, Preschool; Gram-Positive Bacterial Infections; Humans; Male; Meningitis, Bacterial; Micrococcaceae; Neutropenia; Rifampin; Vancomycin

Neonatal Citrobacter koseri (diversus) meningitis is often complicated by the formation of brain abscesses and has a poor neurological outcome with seizures, mental retardation and paresis as sequelae in 50% of the cases. As there is emerging resistance to ampicillin, gentamicin and third-generation cephalosporins, we attempted to treat this infection with carbapenems. Carbapenems in combination with cefotaxime and surgical drainage may play an important role in treating C. koseri meningitis.

Topics: Carbapenems; Cefotaxime; Cephalosporins; Citrobacter; Combined Modality Therapy; Drainage; Enterobacteriaceae Infections; Female; Humans; Infant, Newborn; Meningitis, Bacterial; Prognosis; Treatment Outcome

Despite the lack of evidence defining a time interval during which cerebrospinal fluid (CSF) culture yield will not be affected by previous antibiotic therapy, recent publications cite a "minimum window" of 2 to 3 hours for recovery of bacterial pathogens after parenteral antibiotic administration. We conducted a retrospective review of children with bacterial meningitis to describe the rate at which parenteral antibiotic pretreatment sterilizes CSF cultures.. The medical records of pediatric patients who were discharged from a tertiary children's hospital during a 5-year period with the final diagnosis of bacterial meningitis or suspected bacterial meningitis were reviewed. The decay in yield of CSF cultures over time was evaluated in patients with lumbar punctures (LP) delayed until after initiation of parenteral antibiotics and in patients with serial LPs before and after initiation of parenteral antibiotics.. The pathogens that infected the 128 study patients were Streptococcus pneumoniae (49), Neisseria meningitidis (37), group B Streptococcus (21), Haemophilus influenzae (8), other organisms (11), and undetermined (3). Thirty-nine patients (30%) had first LPs after initiation of parenteral antibiotics, and 55 (43%) had serial LPs before and after initiation of parenteral antibiotics. After >/=50 mg/kg of a third-generation cephalosporin, 3 of 9 LPs in meningococcal meningitis were sterile within 1 hour, occurring as early as 15 minutes, and all were sterile by 2 hours. With pneumococcal disease, the first negative CSF culture occurred at 4.3 hours, with 5 of 7 cultures negative from 4 to 10 hours after initiation of parenteral antibiotics. Reduced susceptibility to beta-lactam antibiotics occurred in 11 of 46 pneumococcal isolates. Group B streptococcal cultures were positive through the first 8 hours after parenteral antibiotics. Blood cultures were positive in 74% of cases without pretreatment and in 57% to 68% of cases with negative CSF cultures.. The temptation to initiate antimicrobial therapy may override the principle of obtaining adequate pretreatment culture material. The present study demonstrates that CSF sterilization may occur more rapidly after initiation of parenteral antibiotics than previously suggested, with complete sterilization of meningococcus within 2 hours and the beginning of sterilization of pneumococcus by 4 hours into therapy. Lack of adequate culture material may result in inability to tailor therapy to antimicrobial susceptibility or in unnecessarily prolonged treatment if the clinical presentation and laboratory data cannot exclude the possibility of bacterial meningitis.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Confidence Intervals; Female; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Patient Selection; Spinal Puncture; Time Factors

Meningitis due to Salmonella is a very rare sign of Salmonellosis. A 10-day-old female premature neonate with Salmonella typhimurium meningitis is presented in this report. The clinical features, outcome and antibiotic treatment are discussed. Although it is extremely rare, Salmonella meningitis should be considered in differential diagnosis of neonatal meningitis.

Topics: Ampicillin; Cefotaxime; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Infant, Newborn; Infusions, Intravenous; Meningitis, Bacterial; Salmonella Infections; Salmonella typhimurium; Treatment Outcome; Turkey

Acute Salmonella typhi meningitis is rare in neonates, mostly reported from developing countries with poor socioeconomic conditions.. A male Caucasian newborn presented with acute Salmonella typhi meningitis at the age of 25 days. His parents had traveled across several African countries under rudimentary hygienic conditions a few months before his birth. Despite early and adapted antibiotic therapy (cefotaxime plus netilmycine), the child developed ischemia in the region of the left sylvian artery.. Salmonella meningitis must be considered while dealing with a sick newborn whose mother has traveled across countries with endemic typhoid.

Topics: Brain Ischemia; Cefotaxime; Cephalosporins; Cerebral Arteries; Cerebral Infarction; Gentamicins; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Netilmicin; Typhoid Fever

The aim of this retrospective study was to evaluate the clinical efficacy in terms of mortality and long-term morbidity of third generation cephalosporins and amikacin in combination for the treatment of gram-negative bacterial meningitis in a homogeneous group of neonates. A 15-year experience (1983-1997) with 72 term neonates without central nervous system anomalies and with gram-negative organisms grown in their cerebrospinal fluid treated with the above combination of antibiotics is presented. All isolated organisms were sensitive to cefotaxime or ceftazidime and to amikacin but 80% were resistant to ampicillin. The predominant infecting organism was Escherichia coli (68.0%) which was sensitive to both cefotaxime and amikacin in all cases but resistant to ampicillin in 48% of cases. Survival at discharge was 97.2% but ultimate survival was reduced to 94.4%, as 2 patients died a few months following discharge of conditions unrelated to meningitis. Ventriculitis was diagnosed in 10 neonates (13.8%). Among survivors, 1 neonate (1.3%) developed hydrocephalus needing shunting and 1 neonate (1.3%) with Proteus mirabilis developed a brain abscess with relapse of meningitis which was successfully treated with a 6-week course of chloramphenicol. At follow-up at an age greater than 6 months, 91.1% of the surviving infants were normal, while 92.3% of survivors at an age greater than 6 years were normal and attended normal school. These results, despite any reservations due to the nature of the study (retrospective, uncontrolled study), strongly support the use of third generation cephalosporins and amikacin in combination for the treatment of neonatal gram-negative bacterial meningitis.

Topics: Amikacin; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Cephalosporin Resistance; Cephalosporins; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Greece; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Morbidity; Retrospective Studies

Topics: Animals; Cefotaxime; Cephalosporins; Humans; Iguanas; Infant, Newborn; Male; Meningitis, Bacterial; Salmonella Infections

We report our experiences in managing a patient with cholesteatoma complicated by meningitis, labyrinthitis and facial nerve palsy. The antero-inferior half of the tympanum was aerated but the postero-superior portion of the tympanic membrane was tightly adherent to the promontry mucosa. An attic perforation was present at the back of the malleolar head. High-resolution computed tomography also uncovered a fistula in the lateral semicircular canal. Surgical exploration of the middle ear cavity demonstrated that both the vestibule and cochlea were filled with cholesteatoma, and the cholesteatoma extended into the internal auditory meatus through the lateral semi-circular canal fistula. The cholesteatoma was removed by opening the vestibule and cochlea with a preservation of the facial nerve. Post-operatively, an incomplete facial palsy remained, but has improved slowly. There is no sign of recurrence to date after a 3-year period of observation.

Topics: Adult; Cefotaxime; Cephalosporins; Cholesteatoma, Middle Ear; Facial Paralysis; Fistula; Humans; Labyrinth Diseases; Labyrinthitis; Male; Meningitis, Bacterial; Tomography, X-Ray Computed

Topics: Alcaligenes; Cefotaxime; Cephalosporins; Female; Gentamicins; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Meningitis, Bacterial; Respiratory Distress Syndrome, Newborn

Topics: Ampicillin; Cefotaxime; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Meningitis, Bacterial; Streptococcal Infections; Streptococcus agalactiae

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Community-Acquired Infections; Cross Infection; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Gram-Negative Bacteria; Humans; Infant, Newborn; Macrolides; Meningitis, Bacterial; Neutropenia; Penicillin Resistance; Penicillins; Pneumonia, Bacterial; Sepsis; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

The history of a 4-week-old infant with meningitis and multiple cerebral abscesses caused by Salmonella enteritidis is reported. Management included successful treatment with a prolonged course of antibiotics, including ciprofloxacin, neurosurgical drainage and long-term immunoglobulin supplements. No adverse effects of joint toxicity were detected.

Topics: Amoxicillin; Ampicillin; Brain Abscess; Cefotaxime; Chloramphenicol; Ciprofloxacin; Drug Therapy, Combination; Female; Humans; Infant; Meningitis, Bacterial; Metronidazole; Salmonella enteritidis; Salmonella Infections

Topics: Administration, Oral; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Cephalosporins; Community-Acquired Infections; Costs and Cost Analysis; Cross Infection; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Humans; Macrolides; Meningitis, Bacterial; Meningitis, Meningococcal; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Neutropenia; Pneumococcal Infections; Pneumonia, Bacterial; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

To study the factors implicated in the infectious process (host, microorganism and antibiotic) of a newborn early sepsis by S. agalactiae that suffered a reactivation at day five from discharge.. Description of two episodes of newborn sepsis by S. agalactiae corresponding to the same patient and microbiologic study of the isolated strain: typing by "genomic macrorestriction" and antibiotic tolerance by "timed killing curves".. It was demonstrated that both strains of S. agalactiae type la/c belonged to the same clone as well as the tolerance to ampicillin of the strain.. This sort of infections processes in the newborn are very serious and there is possibility of relapse. Thus, it is important to study the ethiologic agent and its relationship with antibiotics, in order to stablish the best treatment regimes, avoiding the possibility of relapses as the case we have described.

Topics: Adult; Ampicillin; Ampicillin Resistance; Bacteremia; Cefotaxime; Drug Therapy, Combination; Female; Gentamicins; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Pharynx; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Streptococcal Infections; Streptococcus agalactiae; Vagina

To highlight an unusual organism causing a unilateral endophthalmitis by transplacental spread.. We report a case of Plesiomonas shigelloides endophthalmitis, presenting in a newborn, with co-existing septicaemia and meningitis. There was a significant maternal history of diarrhoea associated with the ingestion of oysters 2 weeks prior to delivery.. The endophthalmitis was treated with parenteral antibiotics and topical mydriatics with complete resolution, although subsequent assessment of the affected eye suggests a poor visual outcome.. Endophthalmitis in the newborn is an unusual clinical finding and usually presents with other manifestations of bacteraemia. Plesiomonas shigelloides is fortunately an infrequent cause of neonatal infection, but is associated with a high degree of morbidity and mortality. We postulate that this neonate acquired P. shigelloides via the transplacental route, and suggest that this organism be included in the list of 'other' causes of transplacental infection that has been abbreviated to 'O' in the acronym 'TORCH'.

Topics: Animals; Bacteremia; Cefotaxime; Cephalosporins; Cyclopentolate; Endophthalmitis; Eye Infections, Bacterial; Female; Food Microbiology; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Male; Maternal-Fetal Exchange; Meningitis, Bacterial; Mydriatics; Ostreidae; Plesiomonas; Pregnancy; Pregnancy Complications, Infectious

Topics: Aged; Blood-Brain Barrier; Cefepime; Cefotaxime; Cephalosporins; Cerebrospinal Fluid; Cerebrospinal Fluid Shunts; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Hydrocephalus; Male; Meningitis, Bacterial; Meropenem; Postoperative Complications; Pseudomonas aeruginosa; Pseudomonas Infections; Thienamycins

Topics: Cefotaxime; Cephalosporins; Humans; Meningitis, Bacterial; Neisseria meningitidis; Neisseriaceae Infections

Topics: Anticonvulsants; Brain; Cefotaxime; Epilepsy, Tonic-Clonic; Haemophilus influenzae; Humans; Infant; Magnetic Resonance Imaging; Male; Meningitis, Bacterial

The clinical course for a patient hospitalized with pneumonia and meningitis due to penicillin-, ceftriaxone-, and cefotaxime-resistant Streptococcus pneumoniae is described. The pneumonia and meningitis responded to antimicrobial therapy, but the patient died following rupture of an infected abdominal aortic aneurysm; gram-positive cocci resembling S. pneumoniae were detected within the aneurysm.

Topics: Aortic Aneurysm, Abdominal; Cefotaxime; Ceftriaxone; Cephalosporins; Drug Resistance, Microbial; Humans; Male; Meningitis, Bacterial; Middle Aged; Penicillins; Pneumonia, Pneumococcal; Streptococcus pneumoniae

Cerebrospinal fluid (CSF) was taken from 19 children with bacterial meningitis treated with cefotaxime (300 mg/kg of body weight/day) and vancomycin (60 mg/kg/day). Median levels of drugs in CSF were smaller than expected, as follows: 4.4 microg/ml for cefotaxime, 3.2 microg/ml for desacetylcefotaxime, and 1.7 microg/ml for vancomycin. The median CSF bactericidal titer against an intermediately cefotaxime-resistant pneumococcus was 1:4. Our data suggest at least an additive interaction between the drugs used in this study.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Cephalosporin Resistance; Cephalosporins; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Infant; Meningitis, Bacterial; Microbial Sensitivity Tests; Pneumococcal Infections; Streptococcus pneumoniae; Vancomycin

While there are concerns about the consequences of widespread use of quinolones, there are few reports of quinolone-resistant strains of Salmonella typhi or Salmonella paratyphi from the Indian subcontinent. We present a case report of a newborn with meningitis due to a quinolone-resistant strain of S. paratyphi B presenting to the Aga Khan University Hospital (AKUH).

Topics: Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Brain Abscess; Cefotaxime; Cephalosporins; Ciprofloxacin; Drug Resistance, Multiple; Drug Therapy, Combination; Female; Histocytochemistry; Humans; Imipenem; Infant, Newborn; Infant, Premature, Diseases; Meningitis, Bacterial; Microbial Sensitivity Tests; Paratyphoid Fever; Salmonella paratyphi B; Thienamycins; Tomography, X-Ray Computed

Salmonella meningitis is a rare entity, even in tropical area where salmonellosis is common. Its prognosis is poor and the choice of adequate antibiotic therapy is difficult.. The files of nine children (three boys, six girls) admitted to the pediatric unit of the Owendo Pediatric Hospital in Libreville for salmonella meningitis between January 1, 1989, and December 31, 1993 were retrospectively studied. Diagnosis was established by a positive culture of cerebrospinal fluid.. Salmonella was the third cause (8.65%) of purulent meningitis observed during this period. Eight children were less than 1-year old, seven were from low socioeconomic standard families. The main clinical manifestations were fever (seven cases), pallor (six cases), diarrhea (four cases), nuchal rigidity (four cases), convulsions (three cases) and bulging fontanel (three cases). Five children (55.5%) were severely anemic (hemoglobin < 5 g/dL) but none had abnormal hemoglobin. Serotyping could not be performed in any case. Salmonella isolates were resistant to chloramphenicol in six cases and to ampicillin in five. Cefotaxime (200 mg/kg/24 h intravenously in three divided doses) was given to seven patients. The duration of therapy was at least 3 weeks in four patients. There were five deaths at ages ranging from 1 to 12 months, ie, a case fatality rate of 55.5%. Three patients (33.3%) recovered with neurological sequels.. The prognosis of salmonella meningitis is poor, even in the case of prompt diagnosis and adequate therapy. Preventive measures only can decrease the risk of illness in children.

Topics: Cefotaxime; Cephalosporins; Child, Preschool; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Gabon; Humans; Infant; Male; Meningitis, Bacterial; Retrospective Studies; Salmonella Infections

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Cross Infection; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Erythromycin; Gram-Negative Bacteria; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Neutropenia; Penicillins; Pneumonia, Mycoplasma; Pneumonia, Staphylococcal; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

The antiinflammatory mediators interleukin (IL)-10 and soluble tumor necrosis factor (TNF) receptors p55 (sTNFR-55) and sTNFR-75 in cerebrospinal fluid (CSF) from 37 children with bacterial meningitis were studied. CSF concentrations of IL-10, sTNFR-55, and sTNFR-75 and of the proinflammatory cytokines TNF-alpha, IL-6, and IL-8 were markedly elevated and were, with the exception of the sTNFRs, significantly higher in CSF than in serum. CSF concentrations of sTNFR- 55 and sTNFR-75 were only associated positively with IL-10 levels. CSF glucose levels correlated highly with levels of IL-10, sTNFR-55, and sTNFR-75 and weakly with TNF-alpha and IL-6. Cytokine levels in CSF decreased rapidly, while sTNFR levels remained elevated for at least 24 h.

Topics: Adolescent; Antigens, CD; Cefotaxime; Ceftazidime; Cephalosporins; Child; Child, Preschool; Cytokines; Female; Humans; Infant; Interleukin-10; Male; Meningitis, Bacterial; Receptors, Tumor Necrosis Factor; Receptors, Tumor Necrosis Factor, Type I; Receptors, Tumor Necrosis Factor, Type II; Tumor Necrosis Factor-alpha

Topics: Bacteremia; Cefotaxime; Cephalosporins; Cerebrospinal Fluid; Dysentery, Bacillary; Humans; Infant; Male; Meningitis, Bacterial; Shigella sonnei

In order to evaluate the antimicrobial activity of meropenem (MEPM), minimum inhibitory concentrations (MICs) of MEPM and control drugs were determined against clinical isolates from blood and cerebrospinal fluid that were obtained from January, 1993 to December, 1994. The results are summarized as follows; 1. The MIC-range, 50% MIC (MIC50) and 90% MIC (MIC90) of MEPM were equal to those of imipenem (IPM) and panipenem (PAPM) against Streptococcus pneumoniae including benzylpenicillin (PCG)-insensitive or -resistant S. pneumoniae, Streptococcus agalactiae and Listeria monocytogenes which are Gram-positive strains, and were stronger than those of ampicillin (ABPC) and cefotaxime (CTX). 2. The MIC-range, MIC50 and MIC90 of these 3 drugs of carbapenems (MEPM, IPM and PAPM) were different against Escherichia coli and Haemophilus influenzae which are Gram-negative strains. The MIC90 of MEPM was < or = 0.025 microgram/ml and those of IPM and PAPM were 0.2 microgram/ml against E. coli. The MIC90 of MEPM was 0.1 microgram/ml, that of IPM was 25 micrograms/ml and that of PAPM was 6.25 micrograms/ml against H. influenzae. Thus, the antimicrobial activity of MEPM was stronger than those of IPM and PAPM. The MIC90's of IPM and PAPM against H. influenzae were high with the MIC of IPM at 12.5 approximately 25 micrograms/ml and the MIC of PAPM at 3.13 approximately 12.5 micrograms/ml against 3 IPM-resistant strains among 17 isolates. 3. The MIC90 of ABPC was 0.39 microgram/ml and that of CTX was 0.1 microgram/ml against 20 strains of S. pneumoniae including 6 strains of PCG-insensitive or resistant S. pneumoniae. The MIC90 of ABPC and CTX were higher than those of 3 carbapenem drugs. There were E. coli of 8 strains with ABPC-high resistance (the MIC of ABPC was > 100 micrograms/ml) and 2 strains for which MIC of CTX were 0.39 microgram/ml and 3.13 micrograms/ml. It was found that 29.4% of H. influenzae were beta-lactamase producing strains. 4. It appeared that antimicrobial activities of carbapenems, particularly MEPM were strong against clinical isolates from blood and cerebrospinal fluid. MEPM will be first choice drug by empiric therapy in infections including sepsis and purulent meningitis.

Topics: Ampicillin; Blood; Cefotaxime; Cephalosporins; Cerebrospinal Fluid; Escherichia coli; Humans; Imipenem; Listeria monocytogenes; Meningitis, Bacterial; Meropenem; Penicillins; Sepsis; Streptococcus agalactiae; Streptococcus pneumoniae; Thienamycins

Topics: Ampicillin; Cefotaxime; Fever of Unknown Origin; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Pasteurella Infections; Pasteurella multocida

In AIDS patients, non-typhoid salmonella metastatic abscesses in lung and brain due to bacteremia have been described previously. Here we present a case in which a group B Salmonella, serotype Copenhagen, caused right parietal subdural empyema. The etiologic diagnosis was based on culture of pus obtained from the lesion. The patient was treated for bacterial meningitis and made a good recovery. He is at present reasonably well and is taking ciprofloxacin as prophylaxis against salmonella relapse.

Topics: Adult; AIDS-Related Opportunistic Infections; Brain; Brain Abscess; Cefotaxime; Chloramphenicol; Ciprofloxacin; Empyema, Subdural; Humans; Male; Meningitis, Bacterial; Salmonella; Salmonella Infections; Serotyping; Tomography, X-Ray Computed

The profound impairment of cellular immunity associated with HIV infection predisposes to salmonella infections with recurrent bacteremia as a well recognized opportunistic infection in patients with AIDS. However, salmonella meningitis is extremely rare in this group of patients and only 4 cases have been reported so far. We present 1 case of recurrent Salmonella enteritidis meningitis in an AIDS patient. The infection recurred despite prolonged antimicrobial therapy. Treatment of salmonella infections in AIDS patients may be very difficult and, in some cases, lifelong maintenance therapy may be required.

Topics: Adult; AIDS-Related Opportunistic Infections; Cefotaxime; Cerebrospinal Fluid; Humans; Male; Meningitis, Bacterial; Recurrence; Salmonella enteritidis; Salmonella Infections

A retrospective study of infants with bacterial meningitis admitted to our hospital during 1949-52, highlighted the lack of 'classical' signs of meningitis in these infants. We carried out a similar review of 44 infants aged less than three months, admitted during 1982-91. We also determined the causative organisms and their antibiotic sensitivities. Symptoms and signs were similar in the two series. Forty infants in the later series were either febrile, irritable or had seizures on the day of admission. Overall mortality fell from 30% to 11%. Between 1982 and 1991 Group B Streptocococcus and Neisseria meningitidis were the commonest causes of meningitis. All organisms, except one, were sensitive to ampicillin and/or cefotaxime. Bacterial meningitis should be suspected in young infants who are febrile, irritable or having seizures. Initial treatment with ampicillin and cefotaxime is appropriate.

Topics: Ampicillin; Cefotaxime; Fever; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Meningitis, Meningococcal; Retrospective Studies; Seizures; Streptococcal Infections; Streptococcus agalactiae

Topics: Adult; Cefotaxime; Humans; Male; Meningitis, Bacterial; Penicillin Resistance; Pneumococcal Infections; Streptococcus pneumoniae; Vancomycin

Topics: Adolescent; Bacteremia; Cefotaxime; Cephalosporins; Humans; Male; Meningitis, Bacterial; Neisseria; Neisseriaceae Infections; Species Specificity; Tooth Avulsion; Virulence

A high proportion of household pets are colonised by Pasteurella multocida. The organism can be transmitted to humans by contact with animal saliva and is a recognised, although rare, cause of meningitis in infancy. Intimate contact between infants and family pets should be discouraged.

Topics: Cefotaxime; Cephalosporins; Humans; Infant; Male; Meningitis, Bacterial; Pasteurella Infections; Pasteurella multocida; Penicillins

Topics: Ampicillin; Catheterization, Peripheral; Catheters, Indwelling; Cefotaxime; Child; Cicatrix, Hypertrophic; Female; Humans; Keloid; Mannitol; Meningitis, Bacterial; Phlebotomy; Skin

Topics: Animals; Bacteria; Bacterial Infections; Cefotaxime; Humans; Infant, Newborn; Intestines; Meningitis, Bacterial; Microbial Sensitivity Tests; Rabbits

Topics: Amoxicillin; Blood; Cefotaxime; Cerebrospinal Fluid Proteins; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Male; Meningitis, Bacterial; Neisseria meningitidis

To our knowledge, we report the first failure of cefotaxime in the treatment of meningitis due to relatively resistant Streptococcus pneumoniae (MICs of penicillin and cefotaxime, 1 microgram/mL). Cure was achieved with a 14-day course of intravenous and intrathecal vancomycin. We recommend that in cases of meningitis caused by strains of S. pneumoniae for which MICs are > or = 1 microgram/mL, cefotaxime should be used with caution; however, if therapeutic failure is suspected therapy should be changed to intravenous and intrathecal vancomycin.

Topics: Adult; Cefotaxime; Drug Resistance, Microbial; Humans; Injections, Intravenous; Injections, Spinal; Male; Meningitis, Bacterial; Penicillin Resistance; Streptococcal Infections; Streptococcus pneumoniae; Vancomycin

Meningitis due to Staphylococcus aureus is uncommon, occurring primarily in patients with known preexisting abnormalities of the CNS (including patients who have undergone previous neurosurgery or trauma). We reviewed our experience with meningitis due to S. aureus in children seen at two medical centers. Among the 40 patients, 32 (80%) had a known predisposing abnormality of the CNS at the time of diagnosis of S. aureus meningitis; all of these 32 patients had had recent neurosurgery, most for placement or revision of a ventriculoperitoneal shunt. Eight patients had no known predisposing CNS abnormality. Four of these eight patients were known to be immunocompromised. The other four patients all had an occult CNS abnormality demonstrated during subsequent workup. Our series demonstrates that when the diagnosis of S. aureus meningitis is made in the absence of a known predisposing CNS abnormality or immunologic defect, then a timely search for an occult CNS abnormality should be undertaken.

Topics: Brain Abscess; Brain Neoplasms; Cefotaxime; Child; Child, Preschool; Chloramphenicol; Dermoid Cyst; Drug Combinations; Female; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Meningocele; Penicillins; Recurrence; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Tomography, X-Ray Computed

In a rabbit Escherichia coli meningitis model, endotoxin liberation and concentrations of leukocytes, tumor necrosis factor (TNF), and lactate were compared after a single intravenous dose of cefotaxime, cefpirome, meropenem, chloramphenicol, or gentamicin. These antibiotics caused a 2- to 10-fold increase in cerebrospinal fluid concentrations of free (filterable) endotoxin within 2 h of starting treatment. By contrast, free endotoxin concentrations increased almost 100-fold in untreated animals 4 h later as bacteria continued to multiply. An initial enhancement of inflammation in the central nervous system occurred in all treatment groups compared with untreated controls. No significant differences were observed between treatment groups except for lower TNF concentrations in chloramphenicol-treated animals. Antibiotic therapy in E. coli meningitis, irrespective of the agent used, may result in an increase in free endotoxin and enhancement of inflammation, but the amount of endotoxin liberated is considerably smaller than that shed by untreated bacteria.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Cefpirome; Cephalosporins; Chloramphenicol; Endotoxins; Escherichia coli Infections; Gentamicins; Inflammation; Male; Meningitis, Bacterial; Meropenem; Rabbits; Thienamycins

In order to assess the benefits of serial assays of C-reactive protein in the course of bacterial meningitis in adults, daily blood samples were taken for CRP measurement during 10 days in 21 consecutive patients (mean age: 24 +/- 8 years) hospitalized for bacterial meningitis principally due to Neisseria meningitidis (n = 15). The highest CRP level (178 +/- 38 mg/l) was present on admission, followed by a regular decrease occurring in uncomplicated meningitis until normal level was achieved on day 9. The CRP kinetics was not influenced by the type of causative micro-organism. This study shows that CRP kinetics in adults is similar to that reported in children. The benefit of CRP assays in optimizing the duration of antibiotic treatment of meningitis needs to be more carefully assessed.

Topics: Adolescent; Adult; Ampicillin; Arthritis; C-Reactive Protein; Cefotaxime; Female; Humans; Male; Meningitis, Bacterial; Middle Aged; Oxacillin; Penicillin G; Prospective Studies

Cefotaxime has been used to treat serious bacterial infections in children since 1982. With the predominant use of cephalosporins in pediatrics, reports of adverse effects of certain compounds have increased. A retrospective review is presented of 2,243 cases of children receiving therapy with cefotaxime in order to evaluate the safety profile and efficacy of cefotaxime in the treatment of serious infections in hospitalized children. Overall, 57 (2.5%) children experienced adverse reactions. These included local reactions in 6 (0.3%), rash in 28 (1.2%), diarrhea in 15 (0.97%), vomiting in 10 (0.7%), abdominal pain in 1 (0.1%), headache in 3 (0.4%), and drug fever in 1 (0.1%). No cases of hemolytic anemia, bleeding, or hyperbilirubinemia were found. Efficacy of treatment for different disease categories ranged from 90.5% to 100%. The percentage of children in any treatment group with a particular laboratory abnormality following initiation of cefotaxime therapy ranged from 0% to 2.6%, and rates of superinfection with bacteria or Candida were 0.4% to 1.7%. Cefotaxime has the distinct advantage of high rates of efficacy and low rates of complications and superinfection among children hospitalized for serious infections.

Topics: Adolescent; Arthritis, Infectious; Bacteremia; Bacterial Infections; Cefotaxime; Cellulitis; Child; Child, Preschool; Female; Humans; Infant; Male; Meningitis, Bacterial; Osteomyelitis; Pneumonia; Retrospective Studies; Treatment Outcome