meropenem and Meningitis

Topics: Adult; Anti-Bacterial Agents; Campylobacter Infections; Campylobacter jejuni; Humans; Infant, Newborn; Meningitis; Meropenem; Middle Aged

17-year-old man had been involved in a traffic accident. He underwent a bilateral craniotomy with artificial dura mater to remove bilateral acute subdural hematomas. Seven months later, a right cranioplasty was performed using frozen auto-bone, and he developed extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae meningitis and an epidural abscess. Since his general status was poor, we could not remove the foreign body (artificial dura mater). He was successfully treated with meropenem and chronic suppression with oral trimethoprim-sulfamethoxazole. By describing this case and the results of a review of the pertinent literature, we discuss the importance of ESBL-producing Klebsiella pneumoniae meningitis in posttraumatic/postoperative patients.

Topics: Adolescent; Anti-Bacterial Agents; beta-Lactamases; Craniotomy; Drug Therapy, Combination; Epidural Abscess; Hematoma, Subdural, Acute; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Meningitis; Meropenem; Postoperative Period; Thienamycins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Meropenem is a parenteral carbapenem that has been used clinically since 1994. Since the first review of its safety profile in 1995, the patient database has increased substantially. This new safety analysis includes data from 46 clinical trials in hospitalized patients with serious bacterial infections. The additional data comprise patients with lower respiratory tract and intra-abdominal infections, septicaemia and meningitis, and cancer patients with febrile neutropenia, and represents a group of more severely ill patients compared with the earlier review. In total, 4872 patients with 5026 meropenem treatment exposures were compared with 4642 patients treated with comparator agents (4752 exposures). Meropenem was administered most often by intravenous injection at 1g or 500 mg every 8 h. Meropenem-related adverse events most frequently reported were diarrhoea (2.3%), rash (1.4%), nausea/vomiting (1.4%) and injection site inflammation (1.1%). The most commonly reported meropenem-related laboratory adverse events were thrombocytosis (1.6%) and increased hepatic enzymes (1.5-4.3%). In meropenem-treated patients with meningitis, the incidence of seizures was low and none were drug related. In patients with infections other than meningitis, the incidence of seizures considered by the investigators to be related to meropenem was 0.08%. In general, the safety profile of meropenem was similar to that of the comparator agents. Withdrawals and deaths were similarly infrequent in the meropenem, cephalosporin and imipenem-cilastatin groups. Increased doses of meropenem were not associated with an increased incidence of adverse events. Meropenem was well tolerated in all patients, including children and patients with neutropenia. This new analysis supports the previous findings that meropenem has a favourable and acceptable safety profile.

Topics: Adult; Anti-Bacterial Agents; Cephalosporins; Child; Child, Preschool; Clindamycin; Diarrhea; Drug Eruptions; Humans; Imipenem; Meningitis; Meropenem; Nausea; Seizures; Thienamycins; Thrombocytosis

Topics: Abdomen; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Humans; Meningitis; Meropenem; Thienamycins

Here we describe an unusual clinical presentation of infection due to Aeromonas hydrophila and underline the importance of a correct microbiological diagnosis for an adequate treatment. A 6-year-old patient with a history of craniotomy with duraplasty the week before consulted for fever and drainage of serosanguineous fluid from the surgical wound. The laboratory parameters were normal and the computed tomography scan showed no relevant changes. Lumbar puncture: leukocytes: 91/mm3; proteins: 89 mg/dL; glucose: 36 mg/dL. Treatment with vancomycin and ceftazidime was started. Cerebrospinal fluid culture: oxidase-positive, glucose-fermenting Gram-negative bacillus. Treatment was changed to meropenem. At 72 hours, using a diffusion method and Vitek 2, it was reported as Aeromonas hydrophila sensitive to trimethoprim-sulfamethoxazole, ciprofloxacin, cefotaxime, and meropenem. The Blue-Carba method was performed to detect carbapenemases; the result was positive. Treatment was changed to trimethoprimsulfamethoxazole. The patient completed 21 days of treatment with a favorable clinical course.. Se describe una presentación clínica inusual de infección por Aeromonas complejo hydrophila y se destaca la importancia del correcto diagnóstico microbiológico para adecuar el tratamiento. Paciente de 6 años consultó por fiebre y drenaje de líquido serohemático de herida quirúrgica por antecedente de craneotomía con duroplastia la semana previa. Laboratorio con parámetros normales y tomografía computada sin cambios relevantes. Punción lumbar: leucocitos 91/mm3, proteínas 89 mg/dl, glucosa 36 mg/dl. Comenzó tratamiento con vancomicina y ceftazidima. Cultivo de líquido cefalorraquídeo: bacilo gramnegativo, oxidasa positivo, fermentador de glucosa. Se rotó a meropenem. A las 72 horas, se informó, por método difusión y Vitek2, Aeromonas complejo hydrophila: sensible a trimetoprimasulfametoxazol, ciprofloxacina, cefotaxima y meropenem. Se realizó método Blue Carba para detección de carbapenemasas con resultado positivo. Se rotó a trimetoprima-sulfametoxazol. Completó 21 días de tratamiento con evolución clínica favorable.

Topics: Aeromonas hydrophila; Anti-Bacterial Agents; beta-Lactamases; Child; Humans; Meningitis; Meropenem

Gram-negative bacillary meningitis remains a rare occurrence, even in patients with human immunodeficiency virus. Current literature only describes anecdotal cases of spontaneous nosocomial Proteus mirabilis meningitis. This report describes the clinical manifestations and management of a patient with healthcare-associated spontaneous Gram-negative bacillary meningitis in a patient with advanced human immunodeficiency virus disease.. A 23-year-old Congolese female was hospitalized in a human immunodeficiency virus specialized center for ongoing weight loss, chronic abdominal pain, and vomiting 9 months after initiation of treatment for tuberculosis meningitis. Hospitalization was complicated by healthcare-associated Gram-negative bacillary meningitis on day 18. Blood and cerebrospinal fluid cultures confirmed Proteus mirabilis. Antibiotic susceptibility testing showed extended spectrum beta-lactamase resistant to common antibiotics, and sensitive to meropenem. Despite initiation of high-dose meropenem by intravenous infusion (2 g every 8 hours), the patient did not improve, and died after 4 days of meropenem treatment. Gram-negative bacillary meningitis remains rare and is associated with an unfavorable prognosis.. This case report highlights the importance of microbiological identification of pathogens in resource-limited settings. As Gram-negative bacillary meningitis does not present with pleocytosis in patients with advanced human immunodeficiency virus, a negative lumbar puncture cannot exclude this diagnosis. Access to clinical bacteriology in resource-limited settings is essential to enable correct antibiotic treatment and avoid overuse of antibiotics to which there is already resistance. It further plays an essential role in public health by identifying antibiotic susceptibilities. Infection prevention and control measures must be reinforced in order to protect patients from such avoidable healthcare-associated infections.

Topics: Adult; Anti-Bacterial Agents; Cross Infection; Female; Gram-Negative Bacteria; HIV; HIV Infections; Humans; Meningitis; Meningitis, Bacterial; Meropenem; Proteus mirabilis; Young Adult

Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM).. This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018.. Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p < 0.05). Microbiological success on Day 3-5, end of treatment (EOT) clinical success (80% vs. 54.8%% vs 57.9%), and overall success (EOT success followed by one-month survival without relapse or reinfection 65% vs. 51.6% vs. 45.3%), EOT all cause mortality (ACM) and day 30 ACM (15% vs. 22.6% vs. 26%) did not differ significantly (p > 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34).. Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Cefepime; Ceftazidime; Delivery of Health Care; Humans; Meningitis; Meropenem; Retrospective Studies; Staphylococcus; Vancomycin

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

The bacterium Campylobacter insulaenigrae was first isolated from marine mammals of Scotland in 2004. Only one case of C. insulaenigrae infection in humans has been previously reported.. An 89-year-old Japanese man without dementia was admitted to our hospital, because he presented with a fever of 38 °C and weakness in right leg since 5 days. He had organized chronic subdural hematoma (CSH), and no history of pre-infection. At the time of admission, he had paralysis of the extraocular muscle, ataxia, and low manual muscle test score of the right side. He was suspected to have Miller Fisher syndrome; however, these symptoms improved without any treatment. On day 22 in the hospital, the patient presented a fever of 38.8 °C, left cranial nerve disorder, and hemiplegia. On day 25, the patient presented with signs of meningeal irritation; cerebrospinal fluid examination indicated an increase in the number of apocytes and a low glucose level. A contrast magnetic resonance imaging (MRI) scan of the patient's head indicated a contrast enhancement effect in his right meninges. The blood culture showed presence of spirillums; 16S rRNA gene sequencing confirmed that the spirillums in the blood culture were Campylobacter insulaenigrae (C. insulaenigrae). We started treatment with meropenem for bacteremia and meningitis. When the symptoms improved, meropenem was replaced with ampicillin, based on the result of the drug sensitivity test. The treatment continued for 4 weeks.. We report the first case of meningitis caused by C. insulaenigrae bacteremia in humans, and the second clinical report of C. insulaenigrae infection in humans. The bacterial strains isolated from humans and marine mammals had different genotypes. This suggests that different genotypes could be responsible for differences in the hosts. Further case studies are needed to establish the reasons behind the difference in the manifestations of C. insulaenigrae infections reported so far.

Topics: Aged, 80 and over; Ampicillin; Bacteremia; Campylobacter; Campylobacter Infections; Humans; Japan; Magnetic Resonance Imaging; Male; Meningitis; Meropenem; Microbial Sensitivity Tests; RNA, Ribosomal, 16S; Sequence Analysis, RNA

Bordetella bronchiseptica is a gram-negative, obligate aerobic coccobacillus known to cause disease in domesticated animals and pets. In humans, B. bronchiseptica commonly leads to respiratory infections like pneumonia or bronchitis, and animal contact usually precedes the onset of symptoms.. We report a case of post-traumatic B. bronchiseptica meningitis without recent surgery in the setting of immunosuppression with a monoclonal antibody. Our case concerns a 77-year-old male with ulcerative colitis on infliximab who sustained a mechanical fall and developed a traumatic cerebrospinal fluid leak complicated by meningitis. He received meropenem then ceftazidime during his hospital course, and temporary neurosurgical drain placement was required. His clinical condition improved, and he was discharged at his baseline neurological status.. B. bronchiseptica is an unusual cause of meningitis that may warrant consideration in immunocompromised hosts with known or suspected animal exposures. To better characterize this rare cause of meningitis, we performed a systematic literature review and summarized all previously reported cases.

Topics: Aged; Animals; Anti-Bacterial Agents; Bordetella bronchiseptica; Bordetella Infections; Ceftazidime; Cerebrospinal Fluid Leak; Colitis, Ulcerative; Drainage; Humans; Immunocompromised Host; Immunosuppressive Agents; Infliximab; Male; Meningitis; Meropenem; Neurosurgical Procedures; Treatment Outcome

Cases of Campylobacter jejuni meningitis are extremely rare. In the literature, less than ten cases have been described so far, although Campylobacter spp is one of the most common pathogens causing gastroenteritis in the world. Some common stigmata can be found across these cases such as rupture of the blood-brain barrier, immunosuppression, as well as the tropism of Camplylobacter jejuni for neurological parenchyma. Campylobacter jejuni bacteremia is certainly underestimated because Campylobacter is a thermophilic bacterium and special conditions are required to isolate this organism in blood cultures. PCR is thus an interesting alternative technique for diagnosis. In our case, a patient with a history of resected astrocytoma, had undergone treatment with chemotherapy and radiotherapy because of anaplastic transformation. The patient was admitted with gastroenteritis and Campylobacter jejuni meningitis. The diagnosis was obtained initially on stool cultures and then by PCR of cerebrospinal fluid. The evolution was favorable with meropenem.. Les cas de méningite à Campylobacter jejuni restent extrêmement rares. Dans la littérature, on décrit moins de 10 cas à ce jour, alors que l’infection à Campylobacter est cependant l'une des causes les plus répandues de gastro-entérite dans le monde. Le point commun de tous ces cas de méningite rapportés semble être la fragilité de la barrière hémato-encéphalique et l’immunodépression, ainsi que le tropisme du Campylobacter jejuni pour les tissus neuronaux. La bactériémie à Campylobacter jejuni est par ailleurs sous-estimée car le germe est thermophilique et des conditions particulières sont nécessaires pour isoler cet organisme dans les hémocultures. La PCR est une alternative intéressante pour le diagnostic microbiologique. Dans le cas décrit, le patient présentait des antécédents d’astrocytome pariéto-temporal droit opéré, avec une transformation anaplasique ayant bénéficié de chimio- et radiothérapie concomitantes. Le patient a été admis avec une gastro-entérite compliquée d’une méningite à Campylobacter jejuni. Le diagnostic a été posé initialement sur la coproculture et ensuite par la PCR du liquide céphalo-rachidien. L’évolution a été favorable sous méropénem.

Topics: Campylobacter Infections; Campylobacter jejuni; Humans; Meningitis; Meropenem; Polymerase Chain Reaction

Within last 15 years, analyzing patterns of etiology and resistance in organisms causing neuroinfections, emergence of resistance has been observed in Slovakia in S. haemolyticus to teicoplanin (11%), Ps. aeruginosa and A. baumannii to meropenem (20%) and Candida spp. (non-albicans Candida spp.) to fluconazol (20%). There are no new antibiotics against carbapenem resistant Ps. aeruginosa and Acinetobacter baumannii.

Topics: Anti-Infective Agents; Brain Diseases; Candidiasis; Cross Infection; Drug Resistance, Microbial; Fluconazole; Humans; Meningitis; Meropenem; Pseudomonas Infections; Staphylococcal Infections; Teicoplanin; Thienamycins

Meropenem is a highly potent carbapenem antibiotic against gram-positive and gram-negative bacteria. Meropenem plasma concentration data from 99 pediatric patients (aged 0.08-17.3 years) were used to develop a population pharmacokinetic model. Pharmacokinetic analysis was performed using NONMEM with exponential interindividual variability and combinational residual error model. A 2-compartment model was found to fit the data best. Creatinine clearance and body weight were the most significant covariates explaining variabilities in meropenem pharmacokinetics among pediatric patients. The validated final model was used to predict meropenem plasma concentrations in 37 pediatric meningitis patients, receiving 40 mg/kg meropenem, who had minimum inhibitory concentration values of the causative pathogens and outcome available. Since the causative pathogens in all patients were eradicated, no break points for required exposure could be found. The microbiological outcomes indicate that the current clinical dosage regimen provides sufficient drug exposure to eradicate the pathogens commonly involved in pediatric meningitis.

Topics: Adolescent; Anti-Bacterial Agents; Body Weight; Child; Child, Preschool; Clinical Trials as Topic; Creatine; Drug Administration Schedule; Haemophilus influenzae type b; Humans; Infant; Kidney; Meningitis; Meropenem; Microbial Sensitivity Tests; Models, Biological; Multicenter Studies as Topic; Neisseria meningitidis; Streptococcus pneumoniae; Thienamycins

Between April 2001 and March 2003, we studied minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) of 7 strains of Streptococcus pneumoniae and 8 strains of Haemophilus influenzae isolated from children with meningitis. The age range of the patients was from 4 months to 5 years. Susceptibilities of ampicillin (ABPC), cefotaxime (CTX), panipenem (PAPM), and vancomycin (VCM) in S. pneumoniae and those of ABPC, CTX, ceftriaxone (CTRX), and meropenem (MEPM) in H. influenzae were measured. MICs of ABPC, CTX, PAPM, and VCM to S. pneumoniae were < or = 0.06-2, < or = 0.06-0.5, < or = 0.06, and 0.25-0.5 microgram/ml and MICs of ABPC, CTX, CTRX, and MEPM to H. influenzae were 0.12-64, < or = 0.06-0.5, < or = 0.06-0.12, and < or = 0.06-0.25 microgram/ml, respectively. In 5 of all strains, difference between MIC and MBC to ABPC was observed. Four strains out of them had mutations of penicillin binding protein genes measured by PCR methods.

Topics: Ampicillin; Cefotaxime; Ceftriaxone; Child, Preschool; Drug Resistance, Bacterial; Haemophilus influenzae; Humans; Infant; Meningitis; Meropenem; Streptococcus pneumoniae; Thienamycins; Vancomycin

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

The transferability of meropenem (MEPM) to cerebrospinal fluid (CSF) was studied employing rabbits with experimental meningitis caused by Staphylococcus aureus. The mean serum concentration was 93.1 +/- 13.5 micrograms/ml at 15 minutes after intravenous administration of MEPM at a dose level of 100 mg/kg. The mean concentration in CSF was maximum at 15 minutes after administration at 4.42 +/- 2.24 micrograms/ml. Pharmacokinetic parameters calculated from these values were as follows: Cmax (CSF/serum) 4.75%, AUC (CSF/serum) 10.4% between 15 and 60 minutes, 13.9% between 15 and 120 minutes and 15.7% between 15 and 180 minutes, T 1/2 for MEPM in CSF: 50.9 minutes, T 1/2 (CSF/serum): 2.19. In comparison to those of imipenem which were obtained in the same way, the transferability of MEPM was similar and in consideration of the antimicrobial potency against the main pathogens of meningitis, it appears worth-while of running clinical trials for this drug.

Topics: Animals; Biological Transport; Half-Life; Meningitis; Meropenem; Rabbits; Staphylococcal Infections; Staphylococcus aureus; Thienamycins