Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter ephesus study.
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Sipahi Oguz Resat, Akyol Deniz, Ormen Bahar, Cicek-Senturk Gonul, Mermer Sinan, Onal Ugur, Amer Fatma, Saed Maysaa Abdallah, Ozdemir Kevser, Tukenmez-Tigen Elif, Oztoprak Nefise, Altin Ummugulsum, Kurtaran Behice, Popescu Corneliu Petru, Sakci Mustafa, Suntur Bedia Mutay, Gautam Vikas, Sharma Megha, Kaya Safak, Akcil Eren Fatma, Kaya Selcuk, Turunc Tuba, Ergen Pınar, Kandemir Ozlem, Cesur Salih, Bardak-Ozcem Selin, Ozgiray Erkin, Yurtseven Taskın, Erdem Huseyin Aytac, Sipahi Hilal, Arda Bilgin, Pullukcu Hüsnü, Tasbakan Meltem, Yamazhan Tansu, Aydemir Sohret, Ulusoy Sercan
Аннотация
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.