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Kraef C, Hertz FB, Riis Olesen B, Sigurdsson ST, Bergdal OK, Gitz Holler J, Mens H, Helweg-Larsen J, Andersen ÅB, Møller K, Knudsen JD. Empiric treatment of healthcare-associated central nervous system infections in Denmark: do we need carbapenems? Infect Dis (Lond) 2024; 56:402-409. [PMID: 38339990 DOI: 10.1080/23744235.2024.2315478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Carbapenems are widely used for empiric treatment of healthcare-associated central nervous system (CNS) infections. We investigated the feasibility of a carbapenem-sparing strategy, utilising a third-generation cephalosporin (ceftriaxone or cefotaxime) (combined with vancomycin) for the empirical treatment of healthcare-associated CNS infections in Eastern Denmark. METHODS The departments of neurosurgery and neuro-intensive care at Copenhagen University Hospital Rigshospitalet. First, we analysed local microbiological data (1st January 2020-31st August 2022) to identify microorganisms non-susceptible to third-generation cephalosporin. Subsequently, we assessed all carbapenem prescriptions over a three-month period for their indication and justification. RESULTS In total, 25,247 bacterial cultures were identified, of which 2,563 CNS-related, were included in the analysis. The positivity rate was 10.5% (n = 257/2439) for cerebrospinal-fluid samples and 75.8% (n = 95/124) for brain parenchyma. CNS samples from five individual patients revealed bacteria non-susceptible to third generation cephalosporins (Enterobacter spp. (n = 3), Pseudomonas spp. (n = 2), Klebsiella spp. (n = 2), Citrobacter freundii (n = 1)). All five patients had been hospitalised for ≥10days at the time-point of antibiotic therapy. Out of 11,626 sets of blood cultures, a total of 10 individual patients had Gram-negative blood-stream infections with resistance to ceftriaxone and piperacillin/tazobactam. 140 days-of-therapy (32%) with carbapenem in 18 patients (36%) were definitively or possibly indicated according to guidelines, none were indicated for healthcare-associated CNS-infections. CONCLUSION An empiric treatment strategy relying on a third-generation cephalosporin appears suitable for healthcare-associated CNS infections at our tertiary hospital, serving a population of 2.6 million. However, in patients with prolonged hospitalization (≥10 days), immunosuppression, prior broad-spectrum antibiotic use, or history of resistant Gram-negative bacteria, empirical prescription of carbapenem may be needed.
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Affiliation(s)
- Christian Kraef
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Frederik Boetius Hertz
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Birthe Riis Olesen
- Hospital Administration/Pharmacy, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sigurdur Thor Sigurdsson
- Department of Neuroanesthesiology, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Ove Ketil Bergdal
- Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Jon Gitz Holler
- Department of Infectious Diseases, Copenhagen University Hospital - North Zealand, Kobenhavn, Denmark
| | - Helene Mens
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Jannik Helweg-Larsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Åse Bengaard Andersen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Kirsten Møller
- Department of Neuroanesthesiology, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Kobenhavn, Denmark
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Sipahi OR, Akyol D, Ormen B, Cicek-Senturk G, Mermer S, Onal U, Amer F, Saed MA, Ozdemir K, Tukenmez-Tigen E, Oztoprak N, Altin U, Kurtaran B, Popescu CP, Sakci M, Suntur BM, Gautam V, Sharma M, Kaya S, Akcil EF, Kaya S, Turunc T, Ergen P, Kandemir O, Cesur S, Bardak-Ozcem S, Ozgiray E, Yurtseven T, Erdem HA, Sipahi H, Arda B, Pullukcu H, Tasbakan M, Yamazhan T, Aydemir S, Ulusoy S. Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter ephesus study. BMC Infect Dis 2023; 23:639. [PMID: 37770836 PMCID: PMC10540455 DOI: 10.1186/s12879-023-08596-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
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.
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Affiliation(s)
- Oguz Resat Sipahi
- 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
| | - Deniz Akyol
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.
- Infectious Diseases Clinic, Kagizman State Hospital, Kagizman, Kars, Turkey.
| | - Bahar Ormen
- Infectious Diseases and Clinical Microbiology Clinic, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Gonul Cicek-Senturk
- Infectious Diseases and Clinical Microbiology Clinic, SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sinan Mermer
- 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
| | - Ugur Onal
- 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
| | | | | | - Kevser Ozdemir
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Denizli, Turkey
| | - Elif Tukenmez-Tigen
- Department of Infectious Diseases and Clinical Microbiology, Marmara University, Istanbul, Turkey
| | - Nefise Oztoprak
- 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
| | - Ummugulsum Altin
- Infectious Diseases and Clinical Microbiology Clinic, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Behice Kurtaran
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University, Adana, Turkey
| | - Corneliu Petru Popescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Mustafa Sakci
- Medical Student, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Bedia Mutay Suntur
- Infectious Diseases and Clinical Microbiology Clinic, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Vikas Gautam
- Post-Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India
| | - Safak Kaya
- Infectious Diseases and Clinical Microbiology Clinic, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Eren Fatma Akcil
- Department of Anaesthesiology and Reanimation, Istanbul University, Istanbul, Turkey
| | - Selcuk Kaya
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Karadeniz Technical University, Trabzon, Turkey
| | - Tuba Turunc
- Department of Infectious Diseases and Clinical Microbiology, Baskent University, Adana, Turkey
| | - Pınar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Goztepe Educational and Research Hospital, Istanbul, Turkey
| | - Ozlem Kandemir
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - Salih Cesur
- Infectious Diseases and Clinical Microbiology Clinic, Ankara Training Hospital, Ankara, Turkey
| | - Selin Bardak-Ozcem
- Department of Infectious Diseases and Clinical Microbiology, Dr. Burhan Nalbantoğlu State Hospital, Nicosia, Northern Cyprus
| | - Erkin Ozgiray
- Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Taskın Yurtseven
- Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Huseyin Aytac Erdem
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Bilgin Arda
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hüsnü Pullukcu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Meltem Tasbakan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Tansu Yamazhan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sohret Aydemir
- Department of Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sercan Ulusoy
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
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