Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter Ephesus study
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...
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| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-023-08596-z |
| _version_ | 1797453724700901376 |
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| author | Oguz Resat Sipahi Deniz Akyol Bahar Ormen Gonul Cicek-Senturk Sinan Mermer Ugur Onal Fatma Amer Maysaa Abdallah Saed Kevser Ozdemir Elif Tukenmez-Tigen Nefise Oztoprak Ummugulsum Altin Behice Kurtaran Corneliu Petru Popescu Mustafa Sakci Bedia Mutay Suntur Vikas Gautam Megha Sharma Safak Kaya Eren Fatma Akcil Selcuk Kaya Tuba Turunc Pınar Ergen Ozlem Kandemir Salih Cesur Selin Bardak-Ozcem Erkin Ozgiray Taskın Yurtseven Huseyin Aytac Erdem Hilal Sipahi Bilgin Arda Hüsnü Pullukcu Meltem Tasbakan Tansu Yamazhan Sohret Aydemir Sercan Ulusoy |
| author_facet | Oguz Resat Sipahi Deniz Akyol Bahar Ormen Gonul Cicek-Senturk Sinan Mermer Ugur Onal Fatma Amer Maysaa Abdallah Saed Kevser Ozdemir Elif Tukenmez-Tigen Nefise Oztoprak Ummugulsum Altin Behice Kurtaran Corneliu Petru Popescu Mustafa Sakci Bedia Mutay Suntur Vikas Gautam Megha Sharma Safak Kaya Eren Fatma Akcil Selcuk Kaya Tuba Turunc Pınar Ergen Ozlem Kandemir Salih Cesur Selin Bardak-Ozcem Erkin Ozgiray Taskın Yurtseven Huseyin Aytac Erdem Hilal Sipahi Bilgin Arda Hüsnü Pullukcu Meltem Tasbakan Tansu Yamazhan Sohret Aydemir Sercan Ulusoy |
| author_sort | Oguz Resat Sipahi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-09T15:27:00Z |
| format | Article |
| id | doaj.art-20321f0834814010bf48662031998013 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-03-09T15:27:00Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-20321f0834814010bf486620319980132023-11-26T12:28:02ZengBMCBMC Infectious Diseases1471-23342023-09-012311910.1186/s12879-023-08596-zEmpirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter Ephesus studyOguz Resat Sipahi0Deniz Akyol1Bahar Ormen2Gonul Cicek-Senturk3Sinan Mermer4Ugur Onal5Fatma Amer6Maysaa Abdallah Saed7Kevser Ozdemir8Elif Tukenmez-Tigen9Nefise Oztoprak10Ummugulsum Altin11Behice Kurtaran12Corneliu Petru Popescu13Mustafa Sakci14Bedia Mutay Suntur15Vikas Gautam16Megha Sharma17Safak Kaya18Eren Fatma Akcil19Selcuk Kaya20Tuba Turunc21Pınar Ergen22Ozlem Kandemir23Salih Cesur24Selin Bardak-Ozcem25Erkin Ozgiray26Taskın Yurtseven27Huseyin Aytac Erdem28Hilal Sipahi29Bilgin Arda30Hüsnü Pullukcu31Meltem Tasbakan32Tansu Yamazhan33Sohret Aydemir34Sercan Ulusoy35Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege UniversityDepartment of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege UniversityInfectious Diseases and Clinical Microbiology Clinic, Izmir Katip Celebi University Ataturk Training and Research HospitalInfectious Diseases and Clinical Microbiology Clinic, SB Diskapi Yildirim Beyazit Training and Research HospitalDepartment of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege UniversityDepartment of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege UniversityZagazig UniversityZagazig UniversityDepartment of Infectious Diseases and Clinical Microbiology, Pamukkale UniversityDepartment of Infectious Diseases and Clinical Microbiology, Marmara UniversityDepartment of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag UniversityInfectious Diseases and Clinical Microbiology Clinic, Bozyaka Training and Research HospitalDepartment of Infectious Diseases and Clinical Microbiology, Cukurova UniversityDr Victor Babes Clinical Hospital of Infectious and Tropical DiseasesMedical Student, Faculty of Medicine, Ege UniversityInfectious Diseases and Clinical Microbiology Clinic, Adana Numune Training and Research HospitalPost-Graduate Institute of Medical Education & ResearchDepartment of Microbiology, All India Institute of Medical Sciences (AIIMS)Infectious Diseases and Clinical Microbiology Clinic, Gazi Yasargil Education and Research HospitalDepartment of Anaesthesiology and Reanimation, Istanbul UniversityDepartment of Infectious Diseases and Clinical Microbiology, Medical Faculty, Karadeniz Technical UniversityDepartment of Infectious Diseases and Clinical Microbiology, Baskent UniversityDepartment of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Goztepe Educational and Research HospitalDepartment of Infectious Diseases and Clinical Microbiology, Mersin University School of MedicineInfectious Diseases and Clinical Microbiology Clinic, Ankara Training HospitalDepartment of Infectious Diseases and Clinical Microbiology, Dr. Burhan Nalbantoğlu State HospitalDepartment of Neurosurgery, Faculty of Medicine, Ege UniversityDepartment of Neurosurgery, Faculty of Medicine, Ege UniversityDepartment of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege UniversityBornova Public Health CenterDepartment of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege UniversityDepartment of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege UniversityDepartment of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege UniversityDepartment of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege UniversityDepartment of Clinical Microbiology, Faculty of Medicine, Ege UniversityDepartment of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege UniversityAbstract 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.https://doi.org/10.1186/s12879-023-08596-zHealthcare-associated meningitisEmpirical therapyMulticenter studyGlycopeptidesAntibiotics |
| spellingShingle | Oguz Resat Sipahi Deniz Akyol Bahar Ormen Gonul Cicek-Senturk Sinan Mermer Ugur Onal Fatma Amer Maysaa Abdallah Saed Kevser Ozdemir Elif Tukenmez-Tigen Nefise Oztoprak Ummugulsum Altin Behice Kurtaran Corneliu Petru Popescu Mustafa Sakci Bedia Mutay Suntur Vikas Gautam Megha Sharma Safak Kaya Eren Fatma Akcil Selcuk Kaya Tuba Turunc Pınar Ergen Ozlem Kandemir Salih Cesur Selin Bardak-Ozcem Erkin Ozgiray Taskın Yurtseven Huseyin Aytac Erdem Hilal Sipahi Bilgin Arda Hüsnü Pullukcu Meltem Tasbakan Tansu Yamazhan Sohret Aydemir Sercan Ulusoy Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter Ephesus study BMC Infectious Diseases Healthcare-associated meningitis Empirical therapy Multicenter study Glycopeptides Antibiotics |
| title | Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter Ephesus study |
| title_full | Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter Ephesus study |
| title_fullStr | Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter Ephesus study |
| title_full_unstemmed | Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter Ephesus study |
| title_short | Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter Ephesus study |
| title_sort | empirical cefepime vancomycin versus ceftazidime vancomycin versus meropenem vancomycin in the treatment of healthcare associated meningitis results of the multicenter ephesus study |
| topic | Healthcare-associated meningitis Empirical therapy Multicenter study Glycopeptides Antibiotics |
| url | https://doi.org/10.1186/s12879-023-08596-z |
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