Meningitis postquirúrgica. Características diferenciales de la meningitis aséptica post-quirúrgica

Ramos‐Martínez, Antonio; Heras-Carballo, T de Las; Fernández-Mateos, Cecilia; Reina, Laura de; Espejo-Montiel, T Alvarez de; Escamilla-Fernández, N; Sánchez-Romero, Isabel; Millán, Isabel

doi:10.1016/s1130-1473(09)70175-7

Cited by 5 publications

(2 citation statements)

References 16 publications

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“…Postneurosurgical meningitis is a serious complication after neurosurgical operation, with an incidence rate of about 3% ( 1 , 2 ) or even up to 20% if catheters are placed for drainage ( 3 ). It is associated with a high mortality rate and severe neurological sequelae if not identified at an early stage and treated in a timely manner with effective antimicrobial agents ( 4 , 5 ). Gram-negative bacteria, especially antibiotic-resistant Acinetobacter baumannii , are emerging as important pathogens of postneurosurgical meningitis in recent years, though Staphylococcus aureus and coagulase-negative Staphylococcus are still more common ( 2 , 3 , 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Population Pharmacokinetics and Dosing Regimen Optimization of Meropenem in Cerebrospinal Fluid and Plasma in Patients with Meningitis after Neurosurgery

Zhang

Chen

et al. 2016

Antimicrob Agents Chemother

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Meropenem is used to manage postneurosurgical meningitis, but its population pharmacokinetics (PPK) in plasma and cerebrospinal fluid (CSF) in this patient group are not well-known. Our aims were to (i) characterize meropenem PPK in plasma and CSF and (ii) recommend favorable dosing regimens in postneurosurgical meningitis patients. Eighty-two patients were enrolled to receive meropenem infusions of 2 g every 8 h (q8h), 1 g q8h, or 1 g q6h for at least 3 days. Serial blood and CSF samples were collected, and concentrations were determined and analyzed via population modeling. Probabilities of target attainment (PTA) were predicted via Monte Carlo simulations, using the target of unbound meropenem concentrations above the MICs for at least 40% of dosing intervals in plasma and at least of 50% or 100% of dosing intervals in CSF. A two-compartment model plus another CSF compartment best described the data. The central, intercentral/peripheral, and intercentral/CSF compartment clearances were 22.2 liters/h, 1.79 liters/h, and 0.01 liter/h, respectively. Distribution volumes of the central and peripheral compartments were 17.9 liters and 3.84 liters, respectively. The CSF compartment volume was fixed at 0.13 liter, with its clearance calculated by the observed drainage amount. The multiplier for the transfer from the central to the CSF compartment was 0.172. Simulation results show that the PTAs increase as infusion is prolonged and as the daily CSF drainage volume decreases. A 4-hour infusion of 2 g q8h with CSF drainage of less than 150 ml/day, which provides a PTA of >90% for MICs of ≤8 mg/liter in blood and of ≤0.5 mg/liter or 0.25 mg/liter in CSF, is recommended. (This study has been registered at ClinicalTrials.gov under identifier NCT02506686.)

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Section: Introductionmentioning

confidence: 99%

Population Pharmacokinetics and Dosing Regimen Optimization of Meropenem in Cerebrospinal Fluid and Plasma in Patients with Meningitis after Neurosurgery

Zhang

Chen

et al. 2016

Antimicrob Agents Chemother

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“…Whether bacterial or aseptic (including viral and chemical) causes are more common is debatable, as this has varied in previous series (6Y9). Grampositive organisms comprise the majority of pathogens in bacterial cases (6,7). Aseptic, often referred to as ''culturenegative,'' meningitis is more common after posterior fossa craniotomy, particularly in operations directly involving the Vth and VIIth cranial nerves (8,10).…”

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confidence: 99%