Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter ephesus study.

Autor: Sipahi OR; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.; Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain., Akyol D; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey. denizakyol416@gmail.com.; Infectious Diseases Clinic, Kagizman State Hospital, Kagizman, Kars, Turkey. denizakyol416@gmail.com., Ormen B; Infectious Diseases and Clinical Microbiology Clinic, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey., Cicek-Senturk G; Infectious Diseases and Clinical Microbiology Clinic, SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey., Mermer S; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ekonomi University, Izmir, Turkey., Onal U; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University, Bursa, Turkey., Amer F; Zagazig University, Zagazig, Egypt., Saed MA; Zagazig University, Zagazig, Egypt., Ozdemir K; Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Denizli, Turkey., Tukenmez-Tigen E; Department of Infectious Diseases and Clinical Microbiology, Marmara University, Istanbul, Turkey., Oztoprak N; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University, Bursa, Turkey.; Infectious Diseases and Clinical Microbiology Clinic, Antalya Education and Research Hospital, Antalya, Turkey., Altin U; Infectious Diseases and Clinical Microbiology Clinic, Bozyaka Training and Research Hospital, Izmir, Turkey., Kurtaran B; Department of Infectious Diseases and Clinical Microbiology, Cukurova University, Adana, Turkey., Popescu CP; Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania., Sakci M; Medical Student, Faculty of Medicine, Ege University, Izmir, Turkey., Suntur BM; Infectious Diseases and Clinical Microbiology Clinic, Adana Numune Training and Research Hospital, Adana, Turkey., Gautam V; Post-Graduate Institute of Medical Education & Research, Chandigarh, India., Sharma M; Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India., Kaya S; Infectious Diseases and Clinical Microbiology Clinic, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey., Akcil EF; Department of Anaesthesiology and Reanimation, Istanbul University, Istanbul, Turkey., Kaya S; Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Karadeniz Technical University, Trabzon, Turkey., Turunc T; Department of Infectious Diseases and Clinical Microbiology, Baskent University, Adana, Turkey., Ergen P; Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Goztepe Educational and Research Hospital, Istanbul, Turkey., Kandemir O; Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey., Cesur S; Infectious Diseases and Clinical Microbiology Clinic, Ankara Training Hospital, Ankara, Turkey., Bardak-Ozcem S; Department of Infectious Diseases and Clinical Microbiology, Dr. Burhan Nalbantoğlu State Hospital, Nicosia, Northern Cyprus., Ozgiray E; Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey., Yurtseven T; Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey., Erdem HA; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey., Sipahi H; Bornova Public Health Center, Izmir, Turkey., Arda B; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey., Pullukcu H; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey., Tasbakan M; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey., Yamazhan T; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey., Aydemir S; Department of Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey., Ulusoy S; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2023 Sep 28; Vol. 23 (1), pp. 639. Date of Electronic Publication: 2023 Sep 28.
DOI: 10.1186/s12879-023-08596-z
Abstrakt: Background: Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM).
Materials/methods: 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.
Results: 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).
Conclusions: 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.
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Databáze: MEDLINE
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