meropenem and Brain-Neoplasms

Meropenem is used to manage postneurosurgical meningitis, but its population pharmacokinetics (PPK) in plasma and cerebrospinal fluid (CSF) in this patient group are not well-known. Our aims were to (i) characterize meropenem PPK in plasma and CSF and (ii) recommend favorable dosing regimens in postneurosurgical meningitis patients. Eighty-two patients were enrolled to receive meropenem infusions of 2 g every 8 h (q8h), 1 g q8h, or 1 g q6h for at least 3 days. Serial blood and CSF samples were collected, and concentrations were determined and analyzed via population modeling. Probabilities of target attainment (PTA) were predicted via Monte Carlo simulations, using the target of unbound meropenem concentrations above the MICs for at least 40% of dosing intervals in plasma and at least of 50% or 100% of dosing intervals in CSF. A two-compartment model plus another CSF compartment best described the data. The central, intercentral/peripheral, and intercentral/CSF compartment clearances were 22.2 liters/h, 1.79 liters/h, and 0.01 liter/h, respectively. Distribution volumes of the central and peripheral compartments were 17.9 liters and 3.84 liters, respectively. The CSF compartment volume was fixed at 0.13 liter, with its clearance calculated by the observed drainage amount. The multiplier for the transfer from the central to the CSF compartment was 0.172. Simulation results show that the PTAs increase as infusion is prolonged and as the daily CSF drainage volume decreases. A 4-hour infusion of 2 g q8h with CSF drainage of less than 150 ml/day, which provides a PTA of >90% for MICs of ≤8 mg/liter in blood and of ≤0.5 mg/liter or 0.25 mg/liter in CSF, is recommended. (This study has been registered at ClinicalTrials.gov under identifier NCT02506686.).

Topics: Adult; Aged; Anti-Bacterial Agents; Brain Injuries, Traumatic; Brain Neoplasms; Drug Administration Schedule; Female; Gram-Negative Bacteria; Humans; Infusions, Intravenous; Male; Meningitis, Bacterial; Meropenem; Microbial Sensitivity Tests; Middle Aged; Monte Carlo Method; Neurosurgery; Postoperative Complications; Prospective Studies; Thienamycins

Caulobacter spp. are Gram-negative bacteria that have rarely been found to be pathogenic in humans.. This report describes the first case, to our knowledge, of meningitis in an adult patient caused by Caulobacter spp. A 75-year-old man was operated for a glioblastoma with no evident signs of primary infection in the wound site. Eight days after surgery, the patient developed signs and symptoms of meningitis. Caulobacter was then isolated on 3 separate occasions in the patient's cerebrospinal fluid. Thereafter, specific antibiotic therapy began. After 2 weeks of therapy, the patient was discharged with complete resolution of any related symptoms.. Caulobacter spp. can cause adult meningitis even where there is no evidence of surgical site infection.

Topics: Aged; Brain Neoplasms; Caulobacter; Cerebrospinal Fluid; Glioblastoma; Gram-Negative Bacterial Infections; Humans; Male; Meningitis, Bacterial; Meropenem; Microbial Sensitivity Tests; Postoperative Complications; Thienamycins; Virulence

We report a case of prostatic abscess in a 22-year-old man with metastatic testicular cancer being treated by BEP (bleomycin, etoposide and cisplatin) chemotherapy. This abscess was successfully treated by surgical drainage with transurethral resection of the prostate (TURP) under the guidance of transrectal ultrasound, allowing the patient to continue be receiving BEP without significant interruption. Drainage TURP is suggested to be a useful strategy for prostate abscess, when prompt control of symptoms caused by prostatic abscess is required.

Topics: Abscess; Adult; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Brain Neoplasms; Ceftazidime; Cisplatin; Drainage; Etoposide; Humans; Immunocompromised Host; Lung Neoplasms; Male; Meropenem; Orchiectomy; Prostatic Diseases; Pseudomonas Infections; Testicular Neoplasms; Thienamycins; Transurethral Resection of Prostate