Roman Mounier1, David Lobo2, Anne Hulin3, Biba Nebbad4, Fabrice Cook2, Gilles Dhonneur2. 1. Anaesthesia and Surgical Intensive Care Unit Department, Henri Mondor University Hospital of Paris-Paris XII School of Medicine, Creteil, France. Electronic address: roman.mounier@hmn.aphp.fr. 2. Anaesthesia and Surgical Intensive Care Unit Department, Henri Mondor University Hospital of Paris-Paris XII School of Medicine, Creteil, France. 3. Pharmacology Laboratory, Biochemistry-Pharmacology Department, Henri Mondor University Hospital of Paris-Paris XII School of Medicine, Creteil, France. 4. Bacteriology Laboratory, Microbiology Department, Henri Mondor University Hospital of Paris-Paris XII School of Medicine, Creteil, France.
Abstract
BACKGROUND: Cerebrospinal fluid (CSF) penetration of vancomycin through the blood-brain barrier is poor but important inflammation improved it. Hence, vancomycin is recommended for the treatment of community meningitis. However, what about mild inflammatory health care-associated meningitis? The aim of this study was to evaluate the impact of vancomycin diffusion on CSF in Staphylococcus epidermidis health care-associated meningitis. CASE DESCRIPTION: This was a retrospective study of all consecutive patients with S. epidermidis CSF shunt-associated infection, which was treated by continuous intravenous vancomycin after standard of care (60 mg/kg/d after a loading dose of 15 mg/kg). Patient outcome, CSF protein level, and vancomycin concentration in CSF and serum were assessed. We report 6 consecutives cases. Clinical and biologic manifestations were of mild intensity. Meningeal permeability was moderately altered with low CSF protein levels. Despite appropriate vancomycin dosage resulting in high serum concentrations, CSF remained below the S. epidermidis minimal inhibitory concentration. CONCLUSIONS: We propose to reassess vancomycin use as first-line therapy when meningeal inflammation is mild-to-moderate in favor of antibiotics, which have a better CSF penetration.
BACKGROUND: Cerebrospinal fluid (CSF) penetration of vancomycin through the blood-brain barrier is poor but important inflammation improved it. Hence, vancomycin is recommended for the treatment of community meningitis. However, what about mild inflammatory health care-associated meningitis? The aim of this study was to evaluate the impact of vancomycin diffusion on CSF in Staphylococcus epidermidis health care-associated meningitis. CASE DESCRIPTION: This was a retrospective study of all consecutive patients with S. epidermidis CSF shunt-associated infection, which was treated by continuous intravenous vancomycin after standard of care (60 mg/kg/d after a loading dose of 15 mg/kg). Patient outcome, CSF protein level, and vancomycin concentration in CSF and serum were assessed. We report 6 consecutives cases. Clinical and biologic manifestations were of mild intensity. Meningeal permeability was moderately altered with low CSF protein levels. Despite appropriate vancomycin dosage resulting in high serum concentrations, CSF remained below the S. epidermidis minimal inhibitory concentration. CONCLUSIONS: We propose to reassess vancomycin use as first-line therapy when meningeal inflammation is mild-to-moderate in favor of antibiotics, which have a better CSF penetration.
Authors: Allan R Tunkel; Rodrigo Hasbun; Adarsh Bhimraj; Karin Byers; Sheldon L Kaplan; W Michael Scheld; Diederik van de Beek; Thomas P Bleck; Joseph R Zunt Journal: Clin Infect Dis Date: 2017-10-15 Impact factor: 9.079