Therapeutic Efficacy of Meropenem for Treatment of Experimental Penicillin-Resistant Pneumococcal Meningitis

Kim, Shin‐Woo; Jin, Joung Hwa; Kang, Soo Jung; Jung, Seung Pil; Kim, So Hyun; Kim, Choon-Kwan; Lee, Hyuck; Oh, Won Sup; Kim, Sung-Min; Peck, Kyong Ran; Song, Jae–Hoon

doi:10.3346/jkms.2004.19.1.21

Cited by 10 publications

(3 citation statements)

References 27 publications

(37 reference statements)

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“…Assim, o meropenem é considerado mais seguro, quando comparado ao imipenem, pelo menor potencial convulsivo. Em Medicina Veterinária, há um estudo utilizando meropenem, associado à vancomicina em coelhos, como terapia eficaz para meningite causada por Streptococcus pneumoniae resistente à penicilina [7]. Não há estudos que comprovem a segurança de carbapenêmicos em gatos, definição de dose terapêutica padronizada, bem como relatos de caso que associem hemólise a sua utilização.…”

Section: Discussionunclassified

Bacterial Otitis by Klebsiella sp. as a Cause of Encephalitis in a Cat

Silveira

Vidor

Dhein

et al. 2018

Acta Scientiae. Vet.

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Background: Meningoencephalitis in cats is usually related to infectious diseases but may also be caused by the extension of bacterial infections originated in the middle or inner ear. This paper seeks to report on a case of encephalitis due to an infection in the middle/inner ear in a 15-year-old cat. The diagnosis was made through brain CT scan and culture and antibiogram of material collected during a ventral osteotomy of the tympanic bulla and reported grave intravascular haemolysis associated to the treatment with antimicrobial imipenem with cilastatin sodium that has already been described in humans but not in small animals in the researched literature.Case: A 15-year-old, male, castrated, Siamese cat was brought to the Veterinary Clinical Hospital of the UFRGS. The animal presented pyrexia and hyporexia, tested negative in the immunoenzymatic test to detect antigens of the FeLV and antibodies of the FIV. The animal had a history of three episodes of tonic convulsion within two days and otitis that hadgone untreated for 10 months prior to the consultation, with apparent spontaneous remission. After blood tests, serum biochemistry profile, abdominal ultrasound scan, chest x-rays and CT scan was requested. It revealed middle and inner otitis in the right ear. It was performed a ventral osteotomy of the right tympanic bulla. Material was collected for culture and antibiogram. It was confirmed that the animal had an inner otitis of bacterial origin by multi-resistant Klebsiella spp. that was sensitive only to antimicrobial imipenem with cilastatin sodium. Fifteen days into the treatment with this antibacterial combination, grave haemolysis was observed, probably associated to the use of the medicine. The patient died on the 17th day of the treatment which was not interrupted as per its owner’s decision. At necropsy, both in the tympanic bulla and liver were found mucous content and whitish lumps. The material collected from the tympanic bulla and cerebrospinal liquid were cultured post-mortem when the bacteria Klebsiella sp. was isolated in the CNS and no bacterial growth was observed in the right tympanic bulla.Discussion: This makes it possible to deduce that there was an intracranial expansion of the otitis which would explain the convulsions and, that due to the use of the antimicrobial agent, the growth of Klebsiella sp. in the tympanic bulla was inhibited. The final diagnosis was bacterial otitis with probable bacterial migration to the brain and liver. Suppurativemeningoencephalitis caused by the expansion of the inflammation deriving from middle/inner otitis has been reported as being the cause of convulsions in cats with bacterial isolation. The bacteria that was isolated from the tympanic bulla is in agreement with the microbiota present in middle/inner otitis in cats. Regarding haemolysis, there are no reports thatlink the use of carbapenems in small animals to it or that mention what the safe therapeutic dosage should be if they were administered. Regarding humans, there have been various reports of haemolytic anaemia caused by this type of medicine including carbapenems. It is also known that, in in vitro tests, imipenem may cause inhibition due to competition from human erythrocyte-glutathione reductase, in charge of defending the erythrocyte against haemolysis. It has been concludedthat meningoencephalitis caused by middle/inner otitis must be included as a differential diagnosis in case of convulsions in cats. Additionally, further studies must be carried out in order to determine both the efficacy and the toxicity of carbapenems in veterinary patients, including studies of the occurrence of grave haemolysis after they are administered.Keywords: meningoencephalitis, computed tomography, convulsions, imipinem, carbapenems.

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Section: Discussionunclassified

Bacterial Otitis by Klebsiella sp. as a Cause of Encephalitis in a Cat

Silveira

Vidor

Dhein

et al. 2018

Acta Scientiae. Vet.

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“…In cases of meningitis caused by rifampin-susceptible strain, the combination of ceftriaxone and rifampin showed a much higher bactericidal activity than that of ceftriaxone and vancomycin or meropenem plus vancomycin [ 23 ]. Animal models of meningitis have demonstrated activity of rifampin paired with one of these agents, even with cephalosporin-resistant organisms [ 24 ]. Therefore, it is suggested that rifampin should be used in combination if the organism is susceptible to rifampin or if there is a delay in the treatment response to regimens without rifampin [ 23 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

First Report of a Case of Pneumococcal Meningitis Which Did Not Respond to the Ceftriaxone Therapy despite the Isolated Organism Being Sensitive to This Antibiotic In Vitro

Mojtabavi

Naderi

Sani

et al. 2011

Case Reports in Pulmonology

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A 60-year-old man presented with pneumococcal meningitis which did not respond to the ceftriaxone therapy, in spite of in-vitro susceptibility (minimal inhibitory concentration of 0.016 μg/dLit) of the isolated organism to this antibacterial agent, although ceftriaxone is still the drug of choice for such pneumococcal meningitis. Review of published articles revealed no report of clinical resistance in organisms which were susceptible to the same antimicrobial agent in vitro. This alarming emergence of isolates with in vivo resistance should be considered and even could lead to a shift in the empirical antibiotic therapy for pneumococcal infections.

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“…El meropenem es una opción que se ha demostrado eficaz en un ensayo clínico 99 , pero en un modelo experimental de meningitis por S. pneumoniae resistente a penicilina, meropenem se mostró inferior a ceftriaxona más vancomicina 100 . No obstante, el panel cree que, al ser un carbapenem de amplio espectro, no debe emplearse en primera línea ya que existen otras opciones de espectro más reducido.…”

Section: Tratamiento Dirigido De Infección Por S Pneumoniaeunclassified