Should we reconsider cefazolin for treating staphylococcal meningitis? A retrospective analysis of cefazolin and cloxacillin cerebrospinal fluid levels in patients treated for staphylococcal meningitis.
Aged
Anti-Bacterial Agents
/ cerebrospinal fluid
Cefazolin
/ cerebrospinal fluid
Chromatography, Liquid
Cloxacillin
/ cerebrospinal fluid
Female
Humans
Male
Mass Spectrometry
Meningitis, Bacterial
/ drug therapy
Middle Aged
Retrospective Studies
Staphylococcal Infections
/ drug therapy
Staphylococcus aureus
/ drug effects
Cefazolin
Cerebrospinal fluid antibiotic dosage
Cloxacillin
Meningitis
Staphylococcus aureus
Staphylococcus epidermidis
Therapeutic drug monitoring
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
24
12
2019
revised:
26
04
2020
accepted:
29
04
2020
pubmed:
22
5
2020
medline:
13
5
2021
entrez:
22
5
2020
Statut:
ppublish
Résumé
To assess the meningeal penetration of cefazolin and cloxacillin in individuals treated for methicillin-susceptible staphylococcal meningitis. We retrospectively identified individuals treated for Staphylococcus meningitis with measurements of cefazolin or cloxacillin concentrations in cerebrospinal fluid (CSF) using a validated assay of liquid chromatography coupled with mass spectrometry at the Nantes University Hospital between January 2009 and October 2019. Staphylococcus meningitis was defined by a compatible clinical presentation and a microbiological confirmation (positive CSF culture or positive specific PCR). Medical charts were retrospectively reviewed to collect microbiological and clinical data, and to assess therapeutic success. Among the 17 included individuals, eight (47%) were treated with cefazolin and nine (53%) with cloxacillin. Median daily dosages of cefazolin and cloxacillin were 8 g (range 6-12 g) and 12 g (range 10-13 g), respectively. Cefazolin and cloxacillin were mainly administered by continuous infusion. Eleven individuals (65%) were men, median (interquartile range (IQR)) age was 54 years (50; 70), 14 (82%) had postoperative meningitis and 3 (18%) had haematogenous meningitis. Median (IQR) antibiotic CSF concentrations were 2.8 mg/L (2.1; 5.2) and 0.66 mg/L (0.5; 0.9) for cefazolin and cloxacillin groups, respectively. Cloxacillin was discontinued in two individuals for therapeutic failure. Patients with staphylococcal meningitis treated with high-dose continuous intravenous infusion of cefazolin achieved therapeutic concentrations in CSF. Cefazolin appears to be a therapeutic candidate that should be properly evaluated in this indication.
Identifiants
pubmed: 32437956
pii: S1198-743X(20)30274-3
doi: 10.1016/j.cmi.2020.04.046
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Cefazolin
IHS69L0Y4T
Cloxacillin
O6X5QGC2VB
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1415.e1-1415.e4Investigateurs
Francois Raffi
(F)
David Boutoille
(D)
Charlotte Biron
(C)
Maeva Lefebvre
(M)
Benjamin Jean Gaborit
(BJ)
Paul Le Turnier
(P)
Colin Deschanvres
(C)
Raphael Lecomte
(R)
Marie Chauveau
(M)
Nathalie Asseray
(N)
Matthieu Gregoire
(M)
Ronan Bellouard
(R)
Guillaume Deslandes
(G)
Eric Dailly
(E)
Anne-Gaëlle Leroy
(AG)
Stéphane Corvec
(S)
Pascale Bémer
(P)
Jocelyne Caillon
(J)
Aurélie Guillouzouic
(A)
Karim Lakhal
(K)
Raphaël Cinotti
(R)
Emmanuel Canet
(E)
Cédric Bretonniere
(C)
Thomas Guimard
(T)
Julia Brochard
(J)
Jean Philippe Talarmin
(JP)
Lydie Katchatourian
(L)
Informations de copyright
Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.