Should we reconsider cefazolin for treating staphylococcal meningitis? A retrospective analysis of cefazolin and cloxacillin CSF levels in patients treated for staphylococcal meningitis.
Clin Microbiol Infect. 2020 May 08;:
Authors: Le Turnier P, Gregoire M, Deslandes G, Lakhal K, Deschanvres C, Lecomte R, Talarmin JP, Dubée V, Bellouard R, Boutoille D, Leroy AG, Gaborit BJ, NAMAP study group Nantes Anti-Microbial Agent Pk/PD
OBJECTIVES: The main objective of the study was to assess the meningeal penetration of cefazolin and cloxacillin in patients treated for methicillin-susceptible staphylococcal meningitis.
METHODS: We retrospectively identified patients treated for Staphylococcus meningitis with measurements of cefazolin or cloxacillin concentrations in cerebrospinal fluid (CSF) using a liquid-chromatography coupled with mass-spectrometry validated assay at the Nantes University Hospital between January 2009 and October 2019. Staphylococcus meningitis was defined by a compatible clinical presentation and a microbiological confirmation (positive CSF culture or positive specific polymerase chain reaction). Medical charts were retrospectively reviewed to collect microbiological, clinical data and to assess therapeutic success.
RESULTS: Among the 17 included patients, 8 (47%) were treated with cefazolin and 9 (53%) with cloxacillin. Median daily dosages of cefazolin and cloxacillin were 8 (range 6-12) and 12 (range 10-13) grams respectively. Cefazolin and cloxacillin were mainly administered via continuous infusion. Eleven patients (65%) were males, median (IQR) age was 54 years (50;70), 14 (82%) had post-operative meningitis and 3 (18%) hematogenous meningitis. Median (IQR) antibiotic CSF concentrations were 2.8 (2.1;5.2) and 0.66 (0.5;0.9) mg/L for cefazolin and cloxacillin groups respectively. Cloxacillin was discontinued in 2 patients for therapeutic failure.
CONCLUSIONS: Patients with staphylococcal meningitis treated with high-dose continuous intravenous infusion of cefazolin achieved therapeutic concentrations in CSF. Cefazolin appears to be a therapeutic candidate which should be properly evaluated in this indication.
PMID: 32437956 [PubMed - as supplied by publisher]