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Pintado V, Pazos R, Jiménez-Mejías ME, Rodríguez-Guardado A, Díaz-Pollán B, Cabellos C, García-Lechuz JM, Lora-Tamayo J, Domingo P, Muñez E, Domingo D, González-Romo F, Lepe-Jiménez JA, Rodríguez-Lucas C, Valencia E, Pelegrín I, Chaves F, Pomar V, Ramos A, Alarcón T, Pérez-Cecilia E. Linezolid for therapy of Staphylococcus aureus meningitis: a cohort study of 26 patients. Infect Dis (Lond) 2020; 52:808-815. [PMID: 32648796 DOI: 10.1080/23744235.2020.1789212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Linezolid has good penetration to the meninges and could be an alternative for treatment of Staphylococcus aureus meningitis. We assessed the efficacy and safety of linezolid therapy for this infection. METHODS Retrospective multicenter cohort study of 26 adults treated with linezolid, derived from a cohort of 350 cases of S. aureus meningitis diagnosed at 11 university hospitals in Spain (1981-2015). RESULTS There were 15 males (58%) and mean age was 47.3 years. Meningitis was postoperative in 21 (81%) patients. The infection was nosocomial in 23 (88%) cases, and caused by methicillin-resistant S. aureus in 15 cases and methicillin-susceptible S. aureus in 11. Linezolid was given as empirical therapy in 10 cases, as directed therapy in 10, and due to failure of vancomycin in 6. Monotherapy was given to 16 (62%) patients. Median duration of linezolid therapy was 17 days (IQR 12-22 days) with a daily dose of 1,200 mg in all cases. The clinical response rate to linezolid was 69% (18/26) and microbiological response was observed in 14 of 15 cases evaluated (93%). Overall 30-day mortality was 23% and was directly associated with infection in most cases. When compared with the patients of the cohort, no significant difference in mortality was observed between patients receiving linezolid or vancomycin for therapy of methicillin-resistant S. aureus meningitis (9% vs. 20%; p = .16) nor between patients receiving linezolid or cloxacillin for therapy of methicillin-susceptible S. aureus meningitis (20% vs 14%; p = .68). Adverse events appeared in 14% (3/22) of patients, but linezolid was discontinued in only one patient. CONCLUSIONS Linezolid appears to be effective and safe for therapy of S. aureus meningitis. Our findings showed that linezolid may be considered an adequate alternative to other antimicrobials in meningitis caused by S. aureus.
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Affiliation(s)
- Vicente Pintado
- Infectious Diseases Service, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Rosario Pazos
- Infectious Diseases Service, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.,Department of Biomedical Sciences and Medicine, Universidade do Algarve, Faro, Portugal
| | - Manuel Enrique Jiménez-Mejías
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | | | - Beatriz Díaz-Pollán
- Infectious Diseases Unit/Department of Internal Medicine, Hospital La Paz, Madrid, Spain
| | - Carmen Cabellos
- Infectious Diseases Service, Hospital Bellvitge, L'Hospitalet, Barcelona, Spain
| | - Juan Manuel García-Lechuz
- Clinical Microbiology Service, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Department of Clinical Microbiology, Hospital Gregorio Marañon, Madrid, Spain
| | | | - Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elena Muñez
- Infectious Diseases Unit, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Diego Domingo
- Microbiology Service, Hospital de La Princesa, Madrid, Spain
| | | | - José Antonio Lepe-Jiménez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | | | - Eulalia Valencia
- Infectious Diseases Unit/Department of Internal Medicine, Hospital La Paz, Madrid, Spain
| | - Iván Pelegrín
- Infectious Diseases Service, Hospital Bellvitge, L'Hospitalet, Barcelona, Spain
| | - Fernando Chaves
- Clinical Microbiology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Virginia Pomar
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Ramos
- Infectious Diseases Unit, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Teresa Alarcón
- Microbiology Service, Hospital de La Princesa, Madrid, Spain
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Rebai L, Fitouhi N, Daghmouri MA, Bahri K. Linezolid for the treatment of postneurosurgical infection caused by methicillin-resistant Staphylococcus. Surg Neurol Int 2019; 10:215. [PMID: 31819809 PMCID: PMC6884953 DOI: 10.25259/sni_455_2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/19/2019] [Indexed: 12/15/2022] Open
Abstract
Background Postneurosurgical infection (PNSI) is a major problem. Linezolid is a bacteriostatic oxazolidinone antibiotic with a highly activity against Gram-positive cocci resistant to methicillin and a good cerebrospinal fluid penetration. The purpose of this study is to evaluate the efficacy of linezolid in the treatment of PNSI caused by methicillin-resistant Staphylococcus (MRS). Methods We conducted an observational study for all patients over 14 years old and diagnosed with MRS PNSI. Demographic, clinical, and laboratory information were collected prospectively. Results A total of 10 patients with PNSI (6 meningitis, 2 ventriculitis, and 2 subdural empyema) received linezolid. MRS isolated was Staphylococcus aureus in seven cases and Staphylococcus epidermidis in three cases. All isolated microorganisms were susceptible to vancomycin (minimum inhibitory concentration (MIC) = 2 mg/L) and linezolid (MIC = 1). The rate of microbiologic efficacy was 100% for patients with meningitis or ventriculitis. In the case of subdural empyema, focal infection had improved between 14 and 18 days. No adverse effects occurred during this study. Conclusion Our results suggest that linezolid as an alternative to vancomycin for the treatment of PNSI caused by MRS with a high rate of efficacy.
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Affiliation(s)
- Lotfi Rebai
- Departments of Anesthesiology and Critical Care Medicine, Uninversity of Tunis El Manar, Tunisia
| | - Nizar Fitouhi
- Departments of Anesthesiology and Critical Care Medicine, Uninversity of Tunis El Manar, Tunisia
| | - Mohamed Aziz Daghmouri
- Departments of Anesthesiology and Critical Care Medicine, Uninversity of Tunis El Manar, Tunisia
| | - Kamel Bahri
- Departments of Neurosurgery, Traumatology and Severe Burns Center, Faculty of Medicine of Tunis, Uninversity of Tunis El Manar, Tunisia
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Anagnos VJ, Hanel RA, Naseri I. Pituitary Abscess: A Rare Clinical Entity in the Presence of Acute Rhinosinusitis: A Case Report. J Neurol Surg Rep 2018; 79:e36-e40. [PMID: 29845000 PMCID: PMC5969996 DOI: 10.1055/s-0038-1656531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/27/2018] [Indexed: 12/21/2022] Open
Abstract
A pituitary abscess is an often-overlooked diagnosis in the clinical presentation of a sellar mass. Due to its rare incidence and nonspecific presentation, diagnosis and treatment is often delayed. The authors describe a 56-year-old male patient presenting with acute onset of severe headache, visual field deficit, and radiologic findings of an expansile sellar lesion. The presenting symptoms were unremarkable for the diagnosis of meningitis, cavernous sinus thrombosis, and septicemia. Recent medical history included symptoms of rhinosinusitis on the days preceding his acute presentation. The initial clinical presentation was suggestive of a possible pituitary apoplexy. Intraoperative findings revealed purulent output upon surgical entry of the sella. Histopathology confirmed the diagnosis of a pituitary abscess. Review of the clinical and radiologic data revealed evidence of multiple opacifications within the paranasal sinuses, along with dehiscence overlying the sellar bone, supporting a diagnosis of secondary pituitary abscess. This case, along with a review of the available literature, will serve to expand our knowledge of this rare disease process that is often overlooked. Clinicians should be mindful of this condition, and include a primary versus secondary pituitary abscess in the differential workup on such cases.
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Affiliation(s)
- Vincent John Anagnos
- Lake Erie College of Osteopathic Medicine, Bradenton Campus, Bradenton, Florida, United States
| | - Ricardo A Hanel
- Department of Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, United States
| | - Iman Naseri
- Department of Surgery - Otolaryngology Head & Neck Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
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