Linezolid in the treatment of methicillin-resistant staphylococcal post-neurosurgical meningitis: A series of 17 cases

Sıpahi, Oğuz Reşat; Bardak, Selin; Turhan, Tuncer; Arda, Bilgin; Pullukçu, Hüsnü; Rükşen, Mete; Aydemir, Şöhret; Dalbastı, Tayfun; Yurtseven, Taşkın; Zılelı, Mehmet; Ulusoy, Sercan

doi:10.3109/00365548.2011.585177

Cited by 34 publications

(23 citation statements)

References 17 publications

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“…Vancomycin does not usually penetrate adequately into the CSF in the absence of inflamed meninges, but when meningitis develops, its penetration increases to a moderate degree [2,3]. Several treatment failures have been reported when IV vancomycin has been used alone, but many patients have been treated successfully with its intrathecal administration [2][3][4]8]. However, intrathecal vancomycin was not used in our study because of possible side effects.…”

Section: Discussionmentioning

confidence: 90%

“…Methicillin-resistant S. aureus is an important cause of hospital-acquired meningitis [1,2,4,5]. Cases of the disease are usually associated with neurosurgical interventions, staphylococcal bacteremia, or a parameningeal focus of infection.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, it has excellent penetration into CSF (CSF:blood ratio > 1) [4,5]. Faella et al [9] used ceftriaxone plus linezolid in seven patients with meningitis caused by penicilin-resistant pneumococci and reported one death, two sequelae (one hearing loss and one severe disability), and four full recoveries.…”

Section: Discussionmentioning

confidence: 99%

“…It is mainly a bacteriostatic antibiotic with relatively high cerebrospinal fluid (CSF) penetration and broad activity against gram-positive pathogens including MRSA. Although linezolid is a bacteriostatic antibiotic, several case reports describe its use in the management of severe infections related to grampositive bacteria, such as meningitis and endocarditis, in which it is standard to use antibiotic drugs that exert bactericidal activity [4,5]. However, no clinical data have been reported for a comparison of vancomycin with linezolid in the management of meningitis.…”

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confidence: 99%

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Vancomycin versus Linezolid in the Treatment of Methicillin-Resistant Staphylococcus aureus Meningitis

Sıpahi

Bardak-Özcem

Turhan

et al. 2013

Surgical Infections

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Vancomycin versus Linezolid in the Treatment of Methicillin-Resistant Staphylococcus aureus Meningitis

Sıpahi

Bardak-Özcem

Turhan

et al. 2013

Surgical Infections

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“…There may be treatment failure in strains with MICs that are Ͼ1 mg/dl, which theoretically may also be associated with a 20-mg/kg vancomycin dosage every 12 h (9). Other treatment modalities are teicoplanin, linezolid, vancomycin combined with rifampin, and intrathecal vancomycin (1,(7)(8)(9).…”

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confidence: 99%

Daptomycin versus Vancomycin in Treatment of Methicillin-Resistant Staphylococcus aureus Meningitis in an Experimental Rabbit Model

Bardak-Özcem

Turhan

Sıpahi

et al. 2013

Antimicrob Agents Chemother

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In this study, we aimed to compare the antibacterial activities of daptomycin and vancomycin in the treatment of methicillinresistant Staphylococcus aureus (MRSA) meningitis (induced by MRSA strain ATCC 43300) in an experimental rabbit meningitis model. After an 8-h period of treatment, bacterial counts decreased significantly in both treatment groups compared to the control group (P < 0.05). However, there was no statistically significant difference between treatment groups. Our results suggest that the antibacterial activity of daptomycin is similar to vancomycin for treatment in the experimental MRSA meningitis model in rabbits. Staphylococcus aureus can cause community-acquired and nosocomial bacterial meningitis and is associated with significant mortality. Methicillin-resistant S. aureus (MRSA) is one of the major etiologic agents in hospital-acquired central nervous system infections. Since the available treatment options are limited, therapy of MRSA meningitis is problematic (1). The aim of this study was to compare the efficacies of vancomycin and daptomycin in MRSA meningitis in an experimental rabbit meningitis model.Bacterial strain. S. aureus ATCC 43300 (vancomycin MIC, 1 mg/liter; daptomycin MIC, 0.064 mg/liter [measured in duplicate using the Etest; AB Biodisk, Solna, Sweden]) was used as the infecting bacterial strain (2).The bacterial solution was prepared in 0.9% NaCl at a concentration of 10 6 CFU/ml as described elsewhere (2, 3). Antimicrobial agents. The drugs used were vancomycin (Lilly, Indianapolis, IN) and daptomycin (Novartis Pharma AG, Basel, Switzerland).Rabbit meningitis model. New Zealand White rabbits weighing 2.5 to 3.0 kg were anesthetized by intramuscular injections of ketamine (35 mg/kg of body weight) and xylazine (5 mg/kg) before each intraventricular intervention, including induction of meningitis and cerebrospinal fluid (CSF) sampling (2). The duration of anesthesia was 10 to 15 min. Then, 0.5 ml of the bacterial solution of MRSA was injected directly into the cisterna magna of each rabbit by using a 22-gauge spinal needle (Hayat Ticaret, Istanbul, Turkey).Animals were not anesthetized after the primary inoculation or between the CSF sampling procedures. In addition, they were kept in their cages, except during intraventricular interventions.Sixteen hours after the inoculation, meningitis criteria were determined. CSF white cell counts of more than 1,000/mm 3 (counted by using a Thoma slide) and a bacterial count of Ն10 3 CFU/ml were accepted as the indications of meningitis. Then, rabbits were separated into three groups: the daptomycin (D) group received one dose of 15 mg/kg daptomycin, and the vancomycin (V) group received 20 mg/kg vancomycin two times (4 h apart) through a peripheral ear vein. The control (C) group did not receive any drug treatment (4).Quantitative bacterial cultures were prepared from CSF samples, which were obtained at the beginning and at 8 hours after treatment. CSF and serum drug levels were measured by a bioassay technique in samples obtained at ...

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Treatment of Infections Due to Resistant Staphylococcus aureus

Anstead

Cadena

Javeri

2013

Methods in Molecular Biology

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This chapter reviews data on the treatment of infections caused by drug-resistant Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). This review covers findings reported in the English language medical literature up to January of 2013. Despite the emergence of resistant and multidrug-resistant S. aureus, we have seven effective drugs in clinical use for which little resistance has been observed: vancomycin, quinupristin-dalfopristin, linezolid, tigecycline, telavancin, ceftaroline, and daptomycin. However, vancomycin is less effective for infections with MRSA isolates that have a higher MIC within the susceptible range. Linezolid is probably the drug of choice for the treatment of complicated MRSA skin and soft tissue infections (SSTIs); whether it is drug of choice in pneumonia remains debatable. Daptomycin has shown to be non-inferior to either vancomycin or β-lactams in the treatment of staphylococcal SSTIs, bacteremia, and right-sided endocarditis. Tigecycline was also non-inferior to comparator drugs in the treatment of SSTIs, but there is controversy about whether it is less effective than other therapeutic options in the treatment of more serious infections. Telavancin has been shown to be non-inferior to vancomycin in the treatment of SSTIs and pneumonia, but has greater nephrotoxicity. Ceftaroline is a broad-spectrum cephalosporin with activity against MRSA; it is non-inferior to vancomycin in the treatment of SSTIs. Clindamycin, trimethoprim-sulfamethoxazole, doxycycline, rifampin, moxifloxacin, and minocycline are oral anti-staphylococcal agents that may have utility in the treatment of SSTIs and osteomyelitis, but the clinical data for their efficacy is limited. There are also several drugs with broad-spectrum activity against Gm-positive organisms that have reached the phase II and III stages of clinical testing that will hopefully be approved for clinical use in the upcoming years: oritavancin, dalbavancin, omadacycline, tedizolid, delafloxacin, and JNJ-Q2. Thus, there are currently many effective drugs to treat resistant S. aureus infections and many promising agents in the pipeline. Nevertheless, S. aureus remains a formidable adversary, and despite our deep bullpen of potential therapies, there are still frequent treatment failures and unfortunate clinical outcomes. The following discussion summarizes the clinical challenges presented by MRSA, the clinical experience with our current anti-MRSA antibiotics, and the gaps in our knowledge on how to use these agents to most effectively combat MRSA infections.

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Linezolid in the treatment of methicillin-resistant staphylococcal post-neurosurgical meningitis: A series of 17 cases

Abstract: Our experience with linezolid suggests that it can be an alternative for the treatment of MRCoNS- and MRSA-related meningitis.

Cited by 34 publications

References 17 publications

Vancomycin versus Linezolid in the Treatment of Methicillin-Resistant Staphylococcus aureus Meningitis

Vancomycin versus Linezolid in the Treatment of Methicillin-Resistant Staphylococcus aureus Meningitis

Daptomycin versus Vancomycin in Treatment of Methicillin-Resistant Staphylococcus aureus Meningitis in an Experimental Rabbit Model

Treatment of Infections Due to Resistant Staphylococcus aureus

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