Methicillin-resistant Staphylococcus aureus (MRSA) sepsis complicated by warm autoimmune haemolytic anaemia secondary to antimicrobial therapy

Ceftaroline for Central Nervous System Infections: Case Report of a Young Infant, and Scoping Review

BACKGROUND

Managing health care acquired and device-associated intracranial infections in young children can be challenging given adverse antibiotic side effects and difficulties in achieving adequate central nervous system (CNS) antibiotic concentrations. Ceftaroline is a cephalosporin with a favorable safety profile and activity against methicillin-resistant Staphylococci and several Gram-negative organisms. Published data on the use of ceftaroline for CNS infections in children and adults are limited.

METHODS

We describe a 2-month-old infant with ventriculo-subgaleal shunt-associated methicillin-resistant Staphylococcus epidermidis ventriculitis, which was successfully treated with ceftaroline, in addition to vancomycin and rifampin. We conducted a scoping review of English-language literature retrieved from PubMed, EMBASE and Web of Science that assessed the use of ceftaroline for CNS infections.

RESULTS

We identified 22 articles for inclusion in our review, which described 92 unique patients, of whom 2 were <21 years old. Ceftaroline was commonly used in conjunction with other antibiotics to treat infections caused by Staphylococcus aureus , coagulase-negative Staphylococci and Streptococcus pneumoniae . Most case reports described clinical success with ceftaroline, though small case series and cohort studies yielded mixed efficacy assessments. Adverse effects attributed to ceftaroline were rare and included reversible myelosuppression, eosinophilia, hepatotoxicity and nephrotoxicity. Pharmacokinetic/pharmacodynamic studies suggested similar CNS penetration through inflamed meninges as other beta lactam antibiotics.

CONCLUSIONS

We identified a growing body of published evidence supporting the use of ceftaroline in combination with other agents for the treatment of CNS infections. In absence of clinical trials, additional real-world data are needed to define the efficacy and safety of ceftaroline for children and adults with CNS infections.

Immediate and Delayed Hypersensitivity Reactions to Antibiotics: Aminoglycosides, Clindamycin, Linezolid, and Metronidazole

Hypersensitivity reactions including IgE-mediated and delayed cell-mediated reactions to aminoglycosides, clindamycin, linezolid, and metronidazole are rare. For aminoglycosides, allergic contact dermatitis is the most frequent reaction for which patch testing can be a useful step in evaluation. For clindamycin, delayed maculopapular exanthems are the most common reactions. There are case reports of clindamycin associated with drug rash with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), acute febrile neutrophilic dermatosis, and symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). For linezolid, cases of hypersensitivity were exceedingly rare and included urticaria, angioedema, anaphylaxis, delayed rashes, and DRESS. For metronidazole, only rare cases were found across a broad spectrum of reactions including allergic contact dermatitis, fixed drug eruption, angioedema, anaphylaxis, serum sickness-like reaction, SJS/TEN, AGEP, SDRIFE, and a possible case of DRESS. IgE-mediated reactions and anaphylaxis to these types of antibiotics are uncommon, and reports of skin testing concentrations and desensitization protocols are largely limited to case reports and series. Non-irritating skin testing concentrations have been reported for gentamycin, tobramycin, and clindamycin. Published desensitization protocols for intravenous and inhaled tobramycin, oral clindamycin, intravenous linezolid, and oral and intravenous metronidazole have also been reported and are reviewed.

Dynamic change of blood profile in rat models with acute skin injury artificially infected with methicillin-resistant Staphylococcus aureus

Background and Aim:

A wound is a common problem for humans and animals. The wound becomes more severe if it is infected by bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA). The wound healing mechanism involves various factors, either in the local tissue or the bloodstream. However, the presentation of infected wound healing regarding its impacts on the dynamic change of blood profile is not clearly understood. This study aimed to explore the impacts of wound creation on the blood profile in rat models with and without being artificially infected by MRSA.

Materials and Methods:

Thirty male Sprague-Dawley rats (6 months old; weight, 300 g) were used as the model. They were divided into three groups: Without wound creation (C), wounded without infection (CW), and wounded and artificially infected by MRSA (CWI). Groups CW and CWI were shaved and induced with 4 mm two-round full-thickness biopsy on the back. Furthermore, group CWI was artificially infected by 105 colony-forming units of MRSA. The blood samples were collected through the tail vein from days 1 to 5. The blood parameters included blood profile, total plasma protein, C-reactive protein, CD4⁺, CD8⁺, CD4⁺/CD8⁺, and COX-2. The data were analyzed using the Statistical Package for the Social Sciences, version 16 (SPSS, IBM, Armonk, NY, USA).

Results:

The result showed that the presentation of a wound with and without MRSA infection significantly changed the total erythrocytes, leukocytes, neutrophils, lymphocytes, total plasma protein, C-reactive protein, and the subset of circulatory CD4⁺, CD8⁺, and COX-2 (p≤0.05). In addition, the wound infected with MRSA impacts the mean corpuscular volume (p≤0.05).

Conclusion:

Moreover, the presentation of the wound with and without MRSA infection induces dynamic changes on various blood profile parameters.