cilastatin--imipenem-drug-combination and Brain-Abscess

We are reporting 6 clinical cases corresponding to admitted patients with intracranial abscesses (4 in brain and 2 in cerebellum) due to chronic otogenic pathology. Five were men and one woman with ages between 25 and 74 years. We have analysed in each case the initial symptoms, otoscopic exam, the otic and cranial CT informed, diagnosis, treatment and evolution. In all of them, it was performed a drainage of the abscess by Neurosurgery and Radical mastoidectomy by our Service with positive result. Although it is an uncommon complication nowdays, the abscesses of otological cause must be always suspected in uncontrolled chronic otitis or poor response to medical treatment. Symptoms can be no characteristics and must be asked for a CT or IRM in case of doubt.

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Brain Abscess; Cefotaxime; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Female; Humans; Imipenem; Male; Metronidazole; Middle Aged; Otitis Media; Tomography, X-Ray Computed

Nocardial infections in an immunocompromised host have been increasingly reported. Nocardial brain abscess, the most common presentation of nocardiosis in the central nervous system, is associated with a high mortality rate because of its delayed diagnosis and its unresponsiveness to the usual antibiotic therapy. We report four patients who experienced a long-term cure of nocardial brain abscess due to treatment by a combination of surgery and postoperative antibiotic therapy; 1 man and 3 women, ages ranging from 43 to 67 years old. Two patients were associated with systemic lupus erythematosus and two with autoimmune hemolytic anemia. Patients underwent surgical aspiration and drainage of brain abscess. Nocardia was identified from the aspirated specimen and postoperative antibiotic therapy for 5-6 weeks was performed using effective antibiotic agents; sulfamethoxazole/trimethoprim (ST), imipenem/cilastatin and minocycline (MINO) in Case 1, ST and MINO in Case 2, erythromycin in Case 3, and panipenem/betamipron and cefotaxime in Case 4. Case 3 and Case 4 with multilobulated brain abscess underwent total excision of the brain abscess. All patients showed successful cure of nocardial brain abscess with no recurrence for the period of 1-8 years. The combination of surgery and postoperative antibiotic therapy provides a good prognosis for nocardial brain abscess.

Topics: Adult; Aged; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; beta-Alanine; Brain Abscess; Cefotaxime; Cilastatin; Cilastatin, Imipenem Drug Combination; Drainage; Drug Combinations; Drug Therapy, Combination; Female; Humans; Imipenem; Immunocompromised Host; Lupus Erythematosus, Systemic; Male; Middle Aged; Minocycline; Nocardia Infections; Postoperative Care; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination