meropenem and Brain-Abscess

Aggregatibacter aphrophilus（A. aphrophilus）is one of the organisms of the HACEK group. Previously reported cases of brain abscesses caused by A. aphrophilus infection have occurred in children with a basis for congenital heart disease, or in adults with a basis for dental disease. Rare cases of brain abscess caused by A. aphrophilus have been reported in adults with congenital heart disease or in patients without dental disease history. Herein we present a rare case of brain abscess caused by A. aphrophilus, who was in association with atrial septal defect for more than 20 years, and had no dental disease and did not develop infective endocarditis.. A 51-year-old female was admitted due to progressively worsening headache and left limb weakness for more than 10 days. She denied the history of chronic diseases such as hypertension and diabetes, and no periodontal disease. While she had a history of atrial septal defect, a form of congenital heart disease with severe pulmonary hypertension for more than 20 years. After admission, echocardiographic illustrated congenital heart disease with severe pulmonary hypertension. CT and MRI showed brain abscess. Cerebrospinal fluid (CSF) results also confirmed the presence of intracranial infection. Empirical therapy with vancomycin 1.0 g i.v q12h and meropenem 2.0 g i.v q8h was initiated from the day of admission. On the fourth day after admission, brain abscess resection and decompressive craniectomy were performed, and the pus drained on operation were cultured and Gram-negative bacilli grew, which was identified as A.aphrophilus. Vancomycin was discontinued and meropenem was continued（2.0 g i.v q8h）for 5 weeks, followed by oral levofloxacin 0.5 qd for 4 weeks of out-patient antibiotics. The patient recovered fully within 9 weeks of treatment.. This is the first case of A. aphrophilus to cause brain abscess in adult with a history of congenital heart disease for more than 20 years, who had no dental disease and did not develop infective endocarditis. We also highlight the value of bacterial 16 S rDNA PCR amplification and sequencing in identifying bacteria in abscesses which are culture-negative, and prompt surgical treatment，choosing effective antibiotics and appropriate course of treatment will get better clinical effect.

Topics: Adult; Aggregatibacter aphrophilus; Anti-Bacterial Agents; Brain Abscess; Child; Endocarditis; Female; Heart Defects, Congenital; Heart Septal Defects, Atrial; Humans; Hypertension, Pulmonary; Meropenem; Middle Aged; Pasteurellaceae Infections; Vancomycin

BACKGROUND Central nervous system infection by the Nocardia species is associated with high morbidity and mortality. Its occurrence in patients with multiple myeloma is rare and acquisition of the infection in such patients was associated with the use of novel therapeutic agents (eg, bortezomib and lenalidomide) or bone marrow transplantation. Here, we report the first case of Nocardia brain abscesses in a patient with multiple myeloma, without the above risk factors. CASE REPORT A 44-year-old woman with IgG-kappa type multiple myeloma presented with generalized tonic-clonic seizures. Magnetic resonance imaging of the brain revealed 3 space-occupying lesions in left frontal, left parietal, and right parietal regions. Craniotomy and enucleation of the left frontal lesion revealed an abscess. The culture result was Nocardia farcinica. The patient was treated with meropenem, amikacin, and trimethoprim-sulfamethoxazole for 6 weeks, followed by trimethoprim-sulfamethoxazole for 12 months, with good outcome. CONCLUSIONS Cerebral nocardiosis is a rare entity and its occurrence in our case may hint toward myeloma-associated humoral immune dysfunction as a pathogenesis and the importance of humoral immunity in the defense against this infection. However, chemotherapy-induced cell-mediated dysfunction cannot be ruled out as a risk factor for the infection. Despite its rarity, this case aims to raise awareness of the condition and reiterate the importance of considering the rare but life-threatening conditions in the differential diagnosis of brain lesions, especially when there is a misdiagnosis of the radiological findings, as occurred in this and previous cases; this avoids delays in appropriate surgical and medical treatment, which can affect outcomes.

Topics: Adult; Amikacin; Antineoplastic Agents; Bortezomib; Brain Abscess; Female; Humans; Immunoglobulin G; Lenalidomide; Meropenem; Multiple Myeloma; Nocardia; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Cerebral abscesses are extremely rare in neonates. Serratia marcescens is an unusual cause of sepsis and neurological spread is especially ominous.. To report the case of a 34-week neonate who developed this rare condition and to discuss diagnostic and therapeutic measures.. A 34-week male neonate sequentially developed respiratory distress syndrome, early sepsis and necrotizing enterocolitis; later cultures revealed S. marcescens. After deterioration, a cerebral abscess became evident, which revealed S. marcescens. Clinical improvement ensued after high-dose amikacin and meropenem.. Clinical signs are often non-specific. Proper diagnostic measures, neurosurgical consultation and aggressive antibiotic therapy are essential for these high-risk neonates.

Topics: Amikacin; Anti-Bacterial Agents; Brain Abscess; Diseases in Twins; Humans; Infant, Newborn; Male; Meropenem; Serratia Infections; Serratia marcescens; Thienamycins

The treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3 rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient's treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41 st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68 th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Carbapenem-Resistant Enterobacteriaceae; Colistin; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Meropenem; Microbial Sensitivity Tests; Tigecycline

We present here the challenging case of severe Lemierre syndrome in a healthy woman in her late twenties, whose clinical presentation was characterised by lung abscesses and disseminated systemic abscesses in the brain, the abdomen and the soft-tissues, as a likely consequence of a patent foramen ovale. Blood cultures were positive for

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Lemierre Syndrome; Meropenem; Metronidazole

Topics: Adult; Amikacin; Anti-Bacterial Agents; Brain Abscess; Carbapenem-Resistant Enterobacteriaceae; Cross Infection; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Meningitis; Meropenem; Microbial Sensitivity Tests; Pneumonia; Sulfamethoxazole

Even in the era of advanced medical treatment, brain abscess still has a high mortality rate. At our institution, brain abscess has been treated mainly using stereotactic or echo-guided aspiration followed by relatively long-term antibiotic treatment, achieving favorable outcomes. To evaluate the efficacy of our strategy involving less-invasive aspiration surgery and long-term selective antibiotic administration for brain abscess, a single-institution series of cases was investigated.. We retrospectively reviewed and analyzed the medical records of 25 cases of brain abscess treated at Saitama Medical University Hospital between 2008 and 2021. The patients comprised 16 men and 9 women aged between 39 and 85 years (median 62 years). Neurosurgical intervention was performed for 23 (92.0%) of the patients and the remaining 2 received antibiotics alone.. Among the neurosurgery patients, 22 (95.7%) underwent echo-guided or stereotactic aspiration, and only 1 underwent craniotomy. Anaerobic bacteria were detected in 11 patients. In the surgical and conservative groups, the median duration of antibiotic treatment was 16 weeks and 23 weeks, respectively. Since 2014 when metronidazole first became available, it has replaced meropenem to cover anaerobic bacteria. The overall mortality rate was 4.0% and a favorable outcome (Glasgow Outcome Scale 4 or 5) was achieved in 76% of the patients. There was no surgical mortality or morbidity.. Most patients underwent aspiration surgery and achieved favorable outcomes. Along with antibiotic treatment for a sufficiently long period to cover anaerobes, this approach can be expected to yield good results.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Brain Abscess; Female; Humans; Male; Meropenem; Metronidazole; Middle Aged; Respiration Disorders; Retrospective Studies; Treatment Outcome

Listeria monocytogenes infective encephalitis is a rare phenomenon, which is more common in people with changed eating habits and immunodeficiency. To the best of our knowledge, listeria brain abscess is even more rare. In this case report, we summarized the clinical characteristics of listeria brain abscess, in order to explore the diagnosis and treatment of Listeria brain abscess, and raise awareness and attention to the disease.. A 64-years-old female patient presented to our institution with 4 days of right arm and leg weakness, the salient past history of the patient was nephrotic syndrome, membranous nephropathy diagnosed 6 months prior, for which she was prescribed glucocorticoids and cyclophosphamide.. Listeria monocytogenes was cultured in the blood of the patient. Comprehensive medical history and imaging features, she was diagnosed as listeria brain abscess.. The patient underwent ampicillin combined with meropenem but not surgery.. The patient recovered without complications. At a 3-month follow-up visit, the condition was better than that before treatment.. Listeria brain abscess is an unusual form of listeriosis, its clinical manifestations lack specificity. Early accurate diagnosis and standardized treatment can effectively promote the recovery of neurological function as well as reduce the morbidity and mortality and improve the prognosis.

Topics: Ampicillin; Anti-Bacterial Agents; Brain Abscess; Female; Humans; Immunocompromised Host; Listeria monocytogenes; Meropenem; Middle Aged; Neuroimaging; Neurologic Examination; Paresis; Treatment Outcome

A 57-year-old woman with amyotrophic lateral sclerosis (ALS) receiving mechanical ventilation developed intractable right temporal headache. She was diagnosed with brain abscess secondary to chronic suppurative otitis media. In this case, the otitis media was caused by nasopharyngeal reflux associated with eustachian tube muscle weakness and a supine position. In addition, ALS patients under mechanical ventilation have a limited ability to convey their pain. Their complaints are often overlooked because many physicians do not know that pain is common in ALS. Physicians should recognize brain abscess as a severe complication of ALS and listen to the complaints of these patients.

Topics: Amyotrophic Lateral Sclerosis; Anti-Bacterial Agents; Brain Abscess; Female; Humans; Meropenem; Middle Aged; Pain; Respiration, Artificial; Treatment Outcome

The management of patients with brain abscess poses a significant challenge to clinicians in patients with chronic kidney disease. Obtaining a biopsy sample from the affected area is the mainstay in the diagnosis, but it is often unavailable. In most cases, therapy is guided by clinical findings and imaging alone. We discuss three cases of brain abscess- each with a different scenario and discuss the issues faced in management. The first case was a 32-year-old post-renal transplant male patient with a brain abscess due to dematiaceous fungi and was treated with amphotericin. The second case was a 42-year-old female patient with stage 5 chronic kidney disease on maintenance hemodialysis who presented with a brain abscess due to suspected fungal infection based on imaging findings and was managed with antibiotics and voriconazole. The third case was a 42-year-old post-renal transplant male patient who presented with a brain abscess due to nocardiosis and was managed with cotrimoxazole, meropenem and linezolid. We also summarize the approach to the management of brain abscess in resource-limited settings.

Topics: Adult; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Brain Abscess; Female; Humans; Kidney Transplantation; Linezolid; Male; Meropenem; Mycoses; Renal Insufficiency, Chronic; Trimethoprim, Sulfamethoxazole Drug Combination; Voriconazole

Topics: Aged; Anti-Bacterial Agents; Brain Abscess; Fusobacterium; Fusobacterium Infections; Humans; Male; Meropenem; Polymerase Chain Reaction

A cerebral abscess (focal infection of brain parenchyma) carries a high mortality and morbidity. Iatrogenic cerebral abscesses are less common and make up 10% of all cases. The presence of a cerebral abscess can rarely improve a patient's prognosis and quality of life, however this case illustrates an abscess and its treatment following a prolonged course of antibiotics leading to resolution of a severe psychotic disorder. This is a case report of a 32-year-old female inpatient at a psychiatric hospital with a long-standing history of congenital hydrocephalus, cerebral palsy and organic delusional disorder who developed an iatrogenic cerebral abscess after insertion of an implantable intracranial pressure monitoring device. After receiving treatment of 6 weeks of intravenous meropenem the patient's mental condition rapidly improved, she became stable and euthymic and was discharged home. The patient has since had no delusions or hallucinations and is living independently at home.

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Brain Abscess; Female; Humans; Iatrogenic Disease; Magnetic Resonance Imaging; Meropenem; Neurophysiological Monitoring; Remission Induction; Schizophrenia, Paranoid

Nocardia species are not commonly referred as primary infectious entities but rather as opportunistic pathogens. Infectious cases of Nocardia spp. in immunocompetent individuals are rare.. An immunocompetent 58-year-old patient presented with recurrent headaches.. A brain abscess was found and surgically drained. Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry and heat shock protein 65/16S-23S rRNA gene intergenic spacer genotyping from the sample revealed the etiological agent as Nocardia beijingensis.. Meropenem/amikacin/Trimethoprim-sulfamethoxazole were administered.. The infection persisted leading to the patient's death.. Here we present the first case of N. beijingensis infection of the central nervous system in an immunocompetent patient from Latin America. Further inquiry is needed to establish whether this species is more virulent than other Nocardia isolates.

Topics: Anti-Bacterial Agents; Brain Abscess; Humans; Latin America; Male; Meropenem; Middle Aged; Nocardia; Nocardia Infections; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Dermacoccus spp. have rarely been reported as human pathogens. We describe a case of a 4-year-old boy with congenital heart disease who was diagnosed with a brain abscess. The abscess was drained and the sample grew Streptococcus intermedius, Aggregatibacter aphrophilus and Dermacoccus sp.. Dermacoccus grew after 5 days of incubation and the patient was treated with meropenem.

Topics: Actinobacteria; Aggregatibacter aphrophilus; Anti-Bacterial Agents; Brain Abscess; Child, Preschool; Coinfection; Drainage; Heart Defects, Congenital; Humans; Male; Meropenem; Pasteurellaceae Infections; Streptococcal Infections; Streptococcus intermedius; Treatment Outcome

A 63-year-old man admitted to hospital for the management of a frontal lobe abscess developed elevated liver enzymes within 48 hours of receiving meropenem. Liver enzymes reached a maximum at 5 days postadministration of meropenem, with alanine aminotransferase 1160 U/L, aspartate aminotransferase 787 U/L, alkaline phosphatase 297 U/L and gamma-glutamyltransferase 252 U/L. Meropenem was ceased and liver function normalised. Meropenem was administered for a second time later in the patient's admission and again the patient developed rapidly increasing liver enzymes, with a mixed hepatocellular/cholestatic pattern. Other possible causes of liver injury were excluded following extensive investigations, and the patient's liver enzymes continued to normalise following meropenem discontinuation. The patient was asymptomatic during the admission and was transferred to a rehabilitation facility. This case demonstrates that meropenem can cause severe liver injury and that early recognition of drug-induced liver injury is important.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Brain Abscess; Chemical and Drug Induced Liver Injury; Early Diagnosis; Frontal Lobe; Humans; Liver; Liver Diseases; Male; Meropenem; Middle Aged

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Brain Abscess; Combined Modality Therapy; Craniotomy; Dexamethasone; Drug Monitoring; Drug Therapy, Combination; Etoposide; Humans; Infusions, Intravenous; Lymphohistiocytosis, Hemophagocytic; Magnetic Resonance Imaging; Male; Meropenem; Neuroimaging; Neutrophil Infiltration; Topoisomerase II Inhibitors; Treatment Outcome

Melioidosis is an uncommon tropical infectious disease caused by Burkholderia pseudomallei. Neurological complications of melioidosis are extremely uncommon in infants. A 10-month-old girl is described who presented with disseminated melioidosis with subcutaneous nodules, arthritis, hepatomegaly and a lung cavity, and developed a left medial rectus palsy. Cranial MRI demonstrated mid-brain, pontine and basal ganglia micro-abscesses. Therapy with meropenem and cotrimoxazole led to resolution of the medial nerve palsy. At 5-month follow-up, the child had no residual neurological deficits.

Topics: Anti-Bacterial Agents; Brain; Brain Abscess; Brain Stem; Burkholderia pseudomallei; Female; Humans; Infant; Magnetic Resonance Imaging; Melioidosis; Meropenem; Thienamycins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A 2-year-old girl presented to hospital, with reduced consciousness and fever. She had a 4-week history of fever treated with two courses of amoxicillin for tonsillitis diagnosed in primary care. Neuroimaging revealed multiple cerebral abscesses and subdural empyema. Pus aspirated from the intracranial collections grew Fusobacterium necrophorum and meropenem was started. Following neurosurgery, the patient continued to be agitated with fluctuating fever. She underwent close monitoring with regular neuroimaging. To control the progression of intracranial infection, she underwent three separate neurosurgical procedures following which she made a good recovery. This case demonstrates how an organism rarely associated with childhood illnesses presented atypically and progressed into a complex potentially fatal intracranial infection requiring a high degree of neurosurgical intervention. Awareness of this organism is important. The combination of source control together with appropriate antibiotic use was crucial in controlling the infection.

Topics: Amoxicillin; Anti-Bacterial Agents; Brain Abscess; Child, Preschool; Empyema, Subdural; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Meropenem; Thienamycins; Tomography, X-Ray Computed

A woman aged 56 years of age had a community-acquired left neck abscess and internal jugular vein thrombosis with septicemia due to extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae. Even though she was treated with intravenous meropenem, the bacteremia persisted. She was complicated with multiple brain abscesses, seizure, and leucopenia. After a combination of intravenous fosfomycin and meropenem, her clinical condition became stable. Combination treatment was continued for 2 months and she recovered. In individual cases of Lemierre syndrome with brain abscess caused by ESBL-producing Enterobacteriaceae, fosfomycin combination therapy may be the alternative choice.

Topics: Anti-Bacterial Agents; beta-Lactamases; Brain; Brain Abscess; Community-Acquired Infections; Drug Therapy, Combination; Female; Fosfomycin; Humans; Infusions, Intravenous; Klebsiella Infections; Klebsiella pneumoniae; Lemierre Syndrome; Meropenem; Middle Aged; Sepsis; Thienamycins; Tomography, X-Ray Computed; Treatment Outcome

A 48-year-old man with a history of a penetrating brain injury was referred with a presumptive diagnosis of bacterial meningitis. Examination revealed a brain abscess in addition to meningitis. Blood and cerebrospinal fluid (CSF) cultures were negative for bacteria, and empirical IV antibiotic therapy with vancomycin (VCM) and meropenem was initiated. Despite initial improvement, however, his condition rapidly deteriorated into coma following intraventricular rupture of the abscess and hydrocephalus. Thereafter, an emergency ventriculostomy was performed and the abscess was evacuated. Bacterial cultures of the pus were negative. To manage the hydrocephalus, 150-200 ml of CSF were drained daily. Intraventricular administration of VCM (20 mg q.d.) was added to the IV antibiotic therapeutic regimen after surgery. Although the primary abscess rapidly decreased in size, ependymitis developed in the fourth ventricle. This new lesion, which resulted from CSF dissemination from the primary abscess, was refractory to treatment, and eventually disappeared after the intraventricular VCM dosage was increased from 20 to 30 mg and continued for 30 days. A possible reason for the development of fulminant ependymitis and why it was refractory to treatment despite the shrinkage of the primary lesion may be that physiological CSF flow from the lateral to the fourth ventricle was lost due to CSF drainage, and the stagnant CSF flow coupled with an insufficient VCM level in the fourth ventricle facilitated the rapid growth of pathogens. Although intraventricular antibiotic administration is efficacious for treating ruptured brain abscesses, it may be associated with the unexpected development of secondary lesions.

Topics: Anti-Bacterial Agents; Brain Abscess; Cerebrospinal Fluid Shunts; Ependyma; Humans; Hydrocephalus; Male; Meningitis, Bacterial; Meropenem; Middle Aged; Rupture, Spontaneous; Thienamycins; Vancomycin

Brain abscess formation is a rare complication of intracranial endovascular treatment. To our knowledge, all previous reports of brain abscess formation have been associated with treatments involving the introduction of foreign materials. A 75-year-old man was admitted to hospital for acute stroke. Cerebral angiography revealed occlusion of the left middle cerebral artery (MCA) at the origin of the M2 segment. Intra-arterial thrombolytic therapy was administered but a hemorrhagic event occurred during this process. A brain CT scan revealed a hematoma extending from the left basal ganglia to the left frontal lobe and expansion of the infarct in the left MCA territory. A brain abscess at the hemorrhagic site developed 3 months after symptom onset. This is the first report of a patient with brain abscess formation following intra-arterial thrombolytic treatment. It is important to ensure aseptic technique during endovascular procedures irrespective of the involvement of foreign materials.

Topics: Aged; Anti-Infective Agents; Brain Abscess; Brain Ischemia; Cerebral Angiography; Cerebral Hemorrhage; Endovascular Procedures; Fibrinolytic Agents; Hematoma; Humans; Male; Meropenem; Thienamycins; Thrombolytic Therapy; Tomography, X-Ray Computed; Urokinase-Type Plasminogen Activator

We report a unique case of a toddler (the only one reported) successfully operated on for a medulla oblongata abscess and comment on the influence of neuroimaging modalities in the preoperative planning of the surgical approach.. We report a case of a 20-month-old child with a solitary medulla oblongata abscess. The abscess appeared to be in close proximity to the anterior medulla oblongata, but preoperative planning based on diffusion tensor imaging (DTI) tractography motivated us to try to remove this lesion through a midline suboccipital approach. The ventral medulla oblongata abscess was surgically removed via a telovelar approach. At the anterior wall of the 4th ventricle, a fenestration was made with pus release and evacuation of the cavity. The child was discharged 1 week later with an uneventful and full recovery.. Modern imaging modalities of the nervous system can be very helpful in preoperative planning. Functional visualization of the nervous system provided by modern imaging techniques, such as the DTI tractography, can alter the classic topographic concept of surgical approach. In the case presented, approaching an anterior medulla oblongata abscess based on DTI tractography data, through a suboccipital midline transventricular approach, proved to be an effective and safe technique.

Topics: Ampicillin; Anti-Bacterial Agents; Brain Abscess; Diffusion Tensor Imaging; Female; Humans; Infant; Medulla Oblongata; Meropenem; Neurosurgical Procedures; Staphylococcal Infections; Staphylococcus hominis; Thienamycins; Vancomycin

The incidence of brain abscess remains high, despite the development of novel antibiotics. Vancomycin or carbapenems, which are third-generation cephems, are recommended as standard therapy for bacterial meningitis or brain abscess. The effectiveness of the high-dose meropenem therapy on brain abscess has occasionally been reported. We experienced 2 consecutive cases of brain abscess in adults. The first patient was a 67-year-old man with diplopia, dizziness, and dysesthesia on the left upper and lower extremities. Images of T1-weighted magnetic resonance imaging (MRI) with contrast medium and diffusion-weighted MRI showed a ring enhancing cystic lesion and a high intensity lesion, respectively, in the right pons. The second patient was a 37-year-old man who complained of right hemiparesis. MRI revealed a ring-enhancing cystic mass in the left thalamus. On the basis of MRI findings, patients were diagnosed with brain abscess and were given high-dose meropenem (6g/day) continuously for 2 months. The abscess resolved completely after treatment with meropenem administered intravenously. Further, neurological deficits caused by abscess successfully improved. High-dose meropenem therapy should be considered as an effective treatment for brain abscess, even in the brain stem and basal ganglia, where it is quite difficult to achieve surgical access.

Topics: Adult; Aged; Anti-Bacterial Agents; Brain Abscess; Brain Stem; Humans; Male; Meropenem; Thalamic Diseases; Thienamycins; Treatment Outcome

The efficacy of carbapenems versus cefotaxime (8g/day)+metronidazole (1.5-2g/day) [combined standard chemotherapy (CSC)] for the treatment of brain abscess was compared. Fifty-nine adult patients with brain abscesses received either imipenem or meropenem (3-4g/day) or CSC for a mean of 5 weeks, in addition to neurosurgery in most cases. Cure was obtained in 84.7% of cases; 42/47 (89.4%) on carbapenems [18/22 (81.8%) on imipenem versus 24/25 (96.0%) on meropenem] and 8/12 (66.7%) on CSC (P=0.06). Seven patients with multiple abscesses were treated with imipenem (1 died; cure rate 85.7%), five with meropenem (all survived; cure rate 100%) and five with CSC (2 died; cure rate 60%) (P<0.4). Neurosurgery was performed in 43/59 cases (72.9%); 17 (77.3%) in the imipenem group, 21 (84.0%) in the meropenem group and 5 (41.7%) in the CSC group (P=0.02). There was no significant difference in the rate of relapse requiring re-intervention. Treatment with meropenem was associated with a lower mortality than CSC (P=0.026). Seizures were observed only with carbapenems [8/22 (36.4%) for imipenem versus 2/25 (8.0%) for meropenem; P=0.03]. Carbapenems were more effective than CSC for treatment of brain abscesses. Because meropenem induced significantly fewer seizures than imipenem with at least the same clinical efficacy, the former appears to be a better choice to treat this infection.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Brain Abscess; Female; Humans; Imipenem; Male; Meropenem; Middle Aged; Retrospective Studies; Thienamycins; Treatment Outcome; Young Adult

We report two premature infants who developed multiple brain abscesses following Klebsiella pneumoniae infection. Both the cases were diagnosed by ultrasonogram (USG) and cranial tomography. Abscess had intraventricular communication in one case. One infant was managed conservatively while the other required surgical drainage.

Topics: Amikacin; Anti-Bacterial Agents; Brain Abscess; Humans; Infant, Newborn; Infant, Premature; Klebsiella Infections; Klebsiella pneumoniae; Meropenem; Thienamycins

A very infrequent report of Listeria monocytogenes meningitis and multiple subtentorial abscesses (cerebellar, bulbar, and pontine in location), occurred in an immunocompetent man, and is described and discussed on the ground of the most recent literature evidences regarding the frequency, presentation, and outcome of this disease. The possibility to resort to combination linezolid therapy in patients who appear to be not responsive to first-line treatment of cerebral abscess of definite origin, and the appearance of anemia as an early untoward event of this novel oxazolidinone antibiotic, are also debated.

Topics: Acetamides; Anemia; Anti-Infective Agents; Brain Abscess; Brain Stem; Cerebellar Diseases; Humans; Immunocompetence; Linezolid; Magnetic Resonance Imaging; Male; Meningitis, Listeria; Meropenem; Middle Aged; Oxazolidinones; Thienamycins; Tomography, X-Ray Computed

A 31-year-old female with acute myelocytic leukemia was admitted to our hospital in June 2004. She had complications of brain abscess at the WBC nadir after the second course of induction therapy. However,because the platelet count was low, neurosurgical procedures, including craniotomy/abscess resection, or abscess drainage, were not performed, and we could not detect bacteria or fungus as the cause of brain abscess. Combination therapy with meropenem trihydrate and fosfluconazole was effective. Thereafter, she underwent related peripheral blood stem cell transplantation, and has had no recurrence of brain abscess. Brain abscess during chemotherapy for patients with acute leukemia is commonly due to fungus,particularly Aspergillus, which has a very high fatality rate. Therefore, the treatment of brain abscess without the detection of bacteria and fungus requires combination therapy with antifungal agents and antibiotics. In this case, methionine-positron emission tomography was useful for the evaluation of therapeutic effectiveness for brain abscess.

Topics: Adult; Antifungal Agents; Brain; Brain Abscess; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluconazole; Humans; Leukemia, Myeloid, Acute; Meropenem; Organophosphates; Peripheral Blood Stem Cell Transplantation; Positron-Emission Tomography; Thienamycins; Tomography, X-Ray Computed

Shewanella putrefaciens is a facultatively anaerobic, non-motile, Gram-negative, non-fermentative bacterium. It is found in various environments and has been isolated worldwide. S. putrefaciens is a rare cause of brain abscesses and meningitis. This is a case report of a cerebellar abscess and meningitis caused by Shewanella putrefaciens and Klebsiella pneumoniae in a river trap fisherman.

Topics: Adult; Brain Abscess; Cerebellar Diseases; Gram-Negative Bacterial Infections; Head; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Meningitis, Bacterial; Meropenem; Otitis Media; Radiography; Shewanella putrefaciens; Thienamycins

Responsible for many childhood diseases, group A Streptococcus (GAS) is a rare cause of central nervous system infections. We report the case of a previously healthy boy with brain abscesses caused by M/emm type 12 GAS and review the case in the context of the published literature and recent epidemiological data.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Brain Abscess; California; Dexamethasone; Drainage; Humans; Infant; Male; Meropenem; Streptococcal Infections; Streptococcus pyogenes; Thienamycins; Vancomycin

Topics: Acetamides; Anemia; Anti-Bacterial Agents; Brain Abscess; Drug Therapy, Combination; Humans; Immunocompetence; Linezolid; Male; Meningitis, Listeria; Meropenem; Middle Aged; Oxazolidinones; Thienamycins

Topics: Brain Abscess; Drug Administration Schedule; Drug Resistance, Bacterial; Escherichia coli Infections; Humans; Infant, Newborn; Klebsiella Infections; Meningitis, Bacterial; Meropenem; Sepsis; Thienamycins; Treatment Outcome

This is the second report of a Citrobacter-associated brain abscess in an adult and the first report of its association with an intradural tumor. Excluding those associated with trauma, neurosurgical procedures, and proximity to the skull base, only seven other cases of abscesses associated with intracranial tumors have been published. Five of seven tumor-associated abscesses with a microbiological diagnosis involved gram-negative bacteria, a finding that may indicate a predilection of these microorganisms for intracranial tumors.. A 78-year-old female patient presented with a 6-month history of confusion and personality changes. Her medical history included paroxysmal atrial fibrillation and a 10-day course of high-dose dexamethasone but no other predisposing conditions for sepsis. She was afebrile, had no focal neurological deficits, and had no systemic abnormalities on examination. Computed tomographic imaging revealed a noncalcified, homogeneously enhancing, 3-cm-diameter, extra-axial tumor associated with the right anterior falx cerebri. The tumor did not extend to the skull base.. At craniotomy, 10 to 20 ml of thick pus was found around the posteroinferior surface of the tumor. On extended culture, this material demonstrated Citrobacter koseri growth, which was effectively treated with ceftriaxone followed by meropenem and one repeated abscess aspiration. No systemic source of the infection was found.. The characteristic endothelial invasiveness of Citrobacter and related gram-negative bacteria may predispose to the formation of abscesses in association with intracranial tumors.

Topics: Aged; Brain Abscess; Ceftriaxone; Citrobacter koseri; Craniotomy; Enterobacteriaceae Infections; Female; Frontal Bone; Humans; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma; Meropenem; Thienamycins

Diagnostic laboratories increasingly offer bacterial identification to the species level. The 17 nocardia species known to date differ in their clinical presentation, antibiotic resistance patterns and geographic distribution. The discovery of a new species with pathogenicity for humans calls for the characterization of its clinical and epidemiological properties.. Nocardia isolated from multifocal brain abscesses of an immunocompromised patient were further identified by the analysis of their cellular fatty acids and sequencing of the 16S ribosomal DNA. Quantitative antibiotic resistance testing was performed with E-tests.. The 16S ribosomal DNA analysis showed a 99 % homology to Nocardia cyriacigeorgici. This is the first report of this species as an invasive human pathogen. N. cyriacigeorgici was found susceptible for meropenem, amikacin, ceftriaxon and cotrimoxazole. The combination of surgical drainage and antibiotic treatment for 13 months was curative.. N. cyriacigeorgici has the potential to cause invasive infections at least in immunocompromised patients. Comparing clinical and in vitro characteristics with N. asteroides, the main causative agent of nocardial infections in Europe, we found no clinically relevant differences.

Topics: Amikacin; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; DNA, Ribosomal; Drainage; Humans; Immunocompromised Host; Male; Meropenem; Microbial Sensitivity Tests; Middle Aged; Nocardia; Nocardia Infections; RNA, Ribosomal, 16S; Sequence Homology, Nucleic Acid; Thienamycins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents; Brain Abscess; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Meropenem; Neutrophils; Nocardia Infections; Sarcoidosis, Pulmonary; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

We describe a case of a 25-year-old female with an acute left otomastoiditis, accompanied by a left temporal extradural abscess with moderate perifocal edema and meningitis. Intravenous meropenem (2 g 8-hourly) and intravenous methylprednisolone (40 mg once daily) were commenced empirically. Teicoplanin (400 mg once daily intravenously) was added after 5 days when culture results were available. Teicoplanin was discontinued on day 25 but meropenem and methylprednisolone were continued for a further 15 days, after which the abscess completely resolved without sequelae. No treatment-induced adverse effects or seizures were observed. Thus, in selected patients, antibacterials (in conjunction with a corticosteroid) may be successfully used without surgery to treat brain abscesses and in such circumstances meropenem is a useful option for empiric therapy.

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Brain Abscess; Brain Edema; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Mastoiditis; Meningitis; Meropenem; Methylprednisolone; Teicoplanin; Thienamycins; Tomography, X-Ray Computed

Authors describe the history of a 37-year-old man suffering from multiple purulent brain abscess. The multiple brain abscess evolved primarily from a gluteal abscess to the lung, and secondarily from the lung to the brain by hematogenous spreading of the bacteria. The identification of the pathogene/s was unsuccessful despite numerous bacteriological examination. Despite many regimens of empiric antibacterial therapy the brain abscesses progressed, neurologic state of the patient deteriorated. At long last, the patient was given chloramphenicol. After that, he had no more fever, his consciousness cleared, no more epileptic convulsion occurred and the cell number of the cerebrospinal fluid became normal. The patient was thought to be cured and was sent home. Two months later fever occurred again and it was accompanied by excrutiating headache, increasing disorientation, so the patient was admitted to the hospital. The occurrence of a new brain abscess and purulent meningitis indicated the relapse of the disease. It was again unsuccessful to identify the pathogene/s therefore the authors treated the patient with many empiric antibiotic regimen, all of which-including chloramphenicol too--proved to be uneffective. As all the therapeutic regimens usually used in the treatment of purulent brain abscess were uneffective--including the combinations which have the widest antibacterial spectrum, authors gave meropenem as ultimum refugium. Some days later the fever came to an end, his consciousness cleared, the brain pressure and the cerebrospinal fluid became normal. The patient had no serious complaints in the course of the four years follow up, his residual neurologic symptoms regressed. On the base of this case history, authors suppose that meropenem--which has already proved to have a very wide antibacterial spectrum and to be very effective in the therapy of many kinds of serious bacterial infections--could also become a promising new therapeutic alternative in the treatment of purulent brain abscess.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Drug Combinations; Humans; Magnetic Resonance Imaging; Male; Meropenem; Recurrence; Thienamycins; Tomography, X-Ray Computed

Topics: Brain Abscess; Child; Enterobacter cloacae; Enterobacteriaceae Infections; Humans; Male; Meropenem; Thienamycins