Comparation of vancomycin penetration into cerebrospinal fluid in postoperative intracranial infection and community-acquired meningitis patients

Cai, Yan; Zhou, Le; Wang, Huqing; Zhang, Li; Wang, Jinqiu; Zhang, Kanghuai

doi:10.1111/jcpt.12770

Cited by 11 publications

(10 citation statements)

References 15 publications

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“…Immune response after intracranial infection will lead to higher WBC levels in blood and infected parts to remove pathogens, and the levels of WBC in cerebrospinal fluid after the destruction of the blood-brain barrier will also be higher [ 15 ]. After intracranial infection, the body's immune response leads to an increase in the level of WBC in the blood and local infection to eliminate pathogens, and the level of WBC in the cerebrospinal fluid and the count of nucleated cells in the cerebrospinal fluid increase after the breakdown of the blood-brain barrier [ 16 ]. Immune response after intracranial infection leads to elevated levels of blood and infected local nucleated cells (white blood cells, lymphocytes, and monocytes) to remove pathogens and increased cerebrospinal fluid nucleated cell count after blood-brain barrier damage.…”

Section: Discussionmentioning

confidence: 99%

The Investigation on Nosocomial Infection of Acinetobacter baumannii and the Clinical Analysis of Sequential Therapy of Cefoperazone/Sulbactam Sodium for Intracranial Infection

Xiong

Zeng

Shen

et al. 2022

Computational and Mathematical Methods in Medicine

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Background. Intracranial infection is a serious complication after neurosurgery. According to a survey, the incidence of intracranial infection is about 2.2%-2.6%, and patients with severe symptoms may even pose a threat to their life safety. Objective. To explore the risk factors for intracranial infection caused by Acinetobacter baumannii after surgery and the clinical effect of sequential therapy of cefoperazone/sulbactam sodium. Methods. In this study, a retrospective study was used. In this case-control study, 48 cases of intracranial Acinetobacter baumannii infection after neurosurgery in our hospital from January 2016 to December 2021 were selected as the infection group, and 96 patients without intracranial infection after surgery during the same period were selected as the control group to study all kinds of related factors and analyze the risk factors for intracranial Acinetobacter baumannii infection; in addition, in accordance with the therapeutic regimen for anti-infection, the infection group was divided into the tigecycline group (patients with tigecycline therapy in this group) and the combined group (patients with tigecycline combined with cefoperazone/sulbactam sequential therapy), with 24 cases in each group in order to compare the therapeutic effects of the two groups. Results. Logistic regression factor model results show that increasing age of patients, surgical treatment for intracranial tumor or craniocerebral trauma, postoperative drainage time (≥3 days), and postoperative hospital stay (≥10 days) were the risk factors for postoperative intracranial infection of Acinetobacter baumannii in neurosurgical patients ( P < 0.05 ), and postoperative prophylactic antibiotic treatment can reduce the incidence of intracranial infection ( P < 0.05 ). The cerebrospinal fluid nucleated cell count, serum CRP, and serum PCT in the combined group 72 h after treatment were lower than those in the tigecycline group, and the difference was statistically significant ( P < 0.05 ). Compared with the clinical efficacy after 72-hour treatment, the cure rate and effective rate in the combined treatment group were 83.33% and 16.67%, respectively, and those in the tigecycline group were 54.17% and 33.33%, respectively. The invalid interest rate was 12.50%, and the combined treatment group was superior to the tigecycline group ( P < 0.05 ). Conclusion. For patients with craniocerebral surgery, targeted preventive interventions should be carried out for the risk factors that may lead to intracranial Acinetobacter baumannii infection. The clinical effect of tigecycline combined with cefoperazone and sulbactam sodium sequentially in the treatment of intracranial Acinetobacter baumannii infection is better.

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Section: Discussionmentioning

confidence: 99%

The Investigation on Nosocomial Infection of Acinetobacter baumannii and the Clinical Analysis of Sequential Therapy of Cefoperazone/Sulbactam Sodium for Intracranial Infection

Xiong

Zeng

Shen

et al. 2022

Computational and Mathematical Methods in Medicine

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“…In postoperative intracranial infection patients, CSF/serum ratio was correlated to white blood cell count in CSF, but this was not the case in meningitis patients. Furthermore, CSF protein and glucose level were not correlated with CSF/serum ratio in both patient groups [51]. Abbreviations: C max : maximum concentration, C min : minimum concentration, C peak : peak concentration, C trough : trough concentration, GOS: Glasgow Outcome Scale, IQR: interquartile range, IV: intravenous, NS: not specified, ND: no data, q12h: every 12 h, TDM: therapeutic drug monitoring (A) not reported in study, calculated from individual patient data, "-": same as above.…”

Section: Vancomycin In Meningitismentioning

confidence: 74%

Section: Vancomycinmentioning

confidence: 99%

Efficacy of Vancomycin and Meropenem in Central Nervous System Infections in Children and Adults: Current Update

2022

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The current antimicrobial therapy of bacterial infections of the central nervous system (CNS) in adults and pediatric patients is faced with many pitfalls as the drugs have to reach necessary levels in serum and cross the blood-brain barrier. Furthermore, several studies report that different factors such as the structure of the antimicrobial agent, the severity of disease, or the degree of inflammation play a significant role. Despite the available attempts to establish pharmacokinetic (PK) modeling to improve the required dosing regimen for adults and pediatric patients, conclusive recommendations for the best therapeutic strategies are still lacking. For instance, bacterial meningitis, the most common CNS infections, and ventriculitis, a severe complication of meningitis, are still associated with 10% and 30% mortality, respectively. Several studies report on the use of vancomycin and meropenem to manage meningitis and ventriculitis; therefore, this review aims to shed light on the current knowledge about their use in adults and pediatric patients. Consequently, studies published from 2015 until mid-July 2021 are included, and data about the study population, levels of drugs in serum and cerebrospinal fluid (CSF), and measured PK data in serum and CSF are provided. The overall aim is to provide the readers a recent reference that summarizes the pitfalls and success of the current therapy and emphasizes the importance of performing more studies to improve the clinical outcome of the current therapeutical approach.

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“…Meanwhile, Jalusic et al 23 reported that in patients with ventriculitis, the CSF lactate level, as an indicator of cerebral inflammation, correlates with vancomycin clearance between the central and CSF compartment, where CSF vancomycin concentration increases with CSF lactate level. Moreover, Cai et al 24 reported that in patients with postoperative intracranial infection, the ratio between vancomycin concentrations in the CSF and serum correlates with CSF white blood cell count. Taken together, the results of these studies indicate that the penetration of vancomycin within the CSF changes with the degree of meningeal inflammation.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetic variability of vancomycin in patients with nosocomial meningitis

Okamoto

Furuya

Ito

et al. 2022

Clinical Pharmacy Therapeu

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What is known and objective: High doses of vancomycin are required early in the treatment of nosocomial meningitis. However, the dosage is often reduced later during treatment, irrespective of renal function. This study was designed to investigate the pharmacokinetic variability of vancomycin and the associated factors throughout the treatment course for patients with nosocomial bacterial meningitis.Methods: This study included 17 patients who received vancomycin for nosocomial bacterial meningitis at the Tokyo Women's Medical University Yachiyo Medical Center from April 2013 to May 2020. All patients had their serum vancomycin concentrations and cerebrospinal fluid (CSF) parameters measured within 7 days of initiating treatment (early period) and after 8 days (later period) of treatment.Results and discussion: The relative error between the predicted serum vancomycin concentration and the measured value was significantly higher in the later period than in the early period. In 13 patients who did not have their dosing interval shortened, the vancomycin dosage/serum vancomycin concentration/estimated glomerular filtration rate (D/C/eGFR) ratio significantly decreased in the later period.

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Comparation of vancomycin penetration into cerebrospinal fluid in postoperative intracranial infection and community-acquired meningitis patients

Cited by 11 publications

References 15 publications

The Investigation on Nosocomial Infection of Acinetobacter baumannii and the Clinical Analysis of Sequential Therapy of Cefoperazone/Sulbactam Sodium for Intracranial Infection

The Investigation on Nosocomial Infection of Acinetobacter baumannii and the Clinical Analysis of Sequential Therapy of Cefoperazone/Sulbactam Sodium for Intracranial Infection

Efficacy of Vancomycin and Meropenem in Central Nervous System Infections in Children and Adults: Current Update

Pharmacokinetic variability of vancomycin in patients with nosocomial meningitis

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