Vancomycin versus Linezolid in the Treatment of Methicillin-Resistant Staphylococcus aureus Meningitis

Abstract Background: Vancomycin is the mainstay of treatment for methicillin-resistant Staphylococcus aureus (MRSA) meningitis. However, successful outcomes with linezolid have not been reported in a large series of patients. We conducted a single-center retrospective cohort study to compare vancomycin with linezolid in the treatment of MRSA meningitis. Methods: We extracted data and outcomes for all adult patients (age > 18 years) with culture-proved MRSA meningitis who received vancomycin or linezolid between January 2006 and June 2011. A definite diagnosis of meningitis was based on the isolation of MRSA in at least one cerebrospinal fluid (CSF) culture and findings in CSF that are typical of the infection. Linezolid was given intravenously (IV) at a dosage of 600 mg q12h and vancomycin IV at 500 mg q6h. Results: A total of 8 patients with MRSA meningitis (5 male, 3 female; age [mean -SD] 61.6 -13.2 years) received vancomycin and 9 patients (7 male, 2 female; age 59.1 -15.6 years) received linezolid. All isolated strains of MRSA were susceptible to both vancomycin and linezolid. The rates of microbiologic success with linezolid or vancomycin, in terms of clearance of MRSA from CSF on day 5, were 7/9 and 2/8 (p = 0.044, Fisher exact test). No severe adverse events occurred in either treatment arm of the study. One-month survival of the patients in whom treatment was successful microbiologically was 2/2 in the vancomycin-treated group and 4/7 in the linezolidtreated group. Minimum inhibitory concentration (MIC) data for vancomycin were available for 5/6 treatment failures with vancomycin, and vancomycin MIC values of these five strains were 2 mg/L. Conclusion: Analysis of the findings in the limited cohorts in our study suggests that linezolid is superior to vancomycin for treating MRSA meningitis, especially in cases in which there is a high MIC (2 mg/L) for vancomycin. A clinical study involving larger cohorts may increase the evidence available in relation to this question

Systemic Tumour Metastasis to Cerebral Meningioma: Literature Review with a Case Report

"Tumour-to-tumour metastasis" (TTM) refers to the metastatic deposition from a primary neoplasm to another type of neoplasm within the same patient. While meningiomas have been reported to be the most common intracranial host of malignant metastases, breast and lung carcinomas have been the most frequently reported systemic donor tumours. In the relevant literature, some of the characteristics of meningiomas have been suggested to provide a favourable environment for the metastasis. Furthermore, some factors, such as immunological and hormonal factors, that are thought to make significant contribution to this event prompt research interest. Physiology-based neuroimaging methods, such as perfusion MRI (p-MRI) and proton spectroscopic MRI (proton s-MRI) could be efficient in differentiating TTM characterisation. The current case of this study, a primary breast carcinoma metastasising into two intracranial meningiomas, is presented with a list of pertinent cases reported to date, and literature is reviewed

An Anatomical and Radiological Study for C1 Lateral Mass Screw Fixation

WOS: 000323600800012Morphometrical analysis of 30 dry stored atlas (C1) vertebrae was performed in order to determine the appropriate length of the screws to be placed on the atlas via posterior approach. In addition, a 3D CT scanning was performed on all samples and angles and lengths were measured on radiological data derived from CT scans. The previous morphometric studies carried out on C1 screw fixation were meticulously reviewed. The literature review has revealed that two non-assessed measurement parameters akin to the ideal screw length have been generated in this study. The first of these parameters, the length of the screw in the saggital plane, has been found 17.8 mm on right and 18.72 mm on left sides. The length of the screw in the vertical plane was found 19.06 mm on right and 19.26 mm on left sides. It's clear that the differences between the interval values of the two measurement parameters range between 5.65 mm and 9.25 mm at minimum. According to the measurements and the literature review carried out so far, there is not a standard screw length for C1 lateral mass screwing technique. The screw length is different for every individual. The surgeon to apply C1 lateral mass screwing must calculate the appropriate screw length via pre-operative cervical CT examinations and use the appropriate-sized screws in the operations

Minimally Invasive Detection of IDH1 Mutation With Cell-Free Circulating Tumor DNA and D-2-Hydroxyglutarate, D/L-2-Hydroxyglutarate Ratio in Gliomas

Isocitrate dehydrogenase-1 (IDH1) mutation is accepted as one of the earliest events in tumorigenesis in gliomas. This mutation causes preferential accumulation of D- relative to L-enantiomer of 2-hydroxyglutarate (2-HG). Minimally invasive techniques to detect IDH1 mutation may prove useful for clinical practice. We adopted 2 different diagnostic approaches to detect IDH1 mutation status in glioma patients: Evaluation of D- and L-2-HG levels in cerebrospinal fluid (CSF), urine, and plasma, and identification of IDH1 mutation using cell-free circulating tumor DNA (ctDNA) in CSF and plasma. Forty-nine glioma patients in different stages were included. Levels of D- and L-2-HG were determined using liquid chromatography-tandem mass spectrometry; IDH1 R132H mutation was determined by digital-PCR. D-2-HG levels and D/L-2-HG ratio (rDL) in CSF and rDL in plasma were significantly higher in the mutant group than in the wild-type group (p = 0.029, 0.032, 0.001, respectively). The IDH1 mutation detection rates in CSF- and plasma-ctDNA were 63.2% and 25.0%, respectively. These data indicate that D-2-HG values in CSF and rDL in plasma and CSF can be considered as significant contributors to the identification of IDH1 mutation status. In addition, detection of IDH1 mutation in CSF-ctDNA from glioma patients provides a basis for future use of ctDNA for minimally invasive clinical assessment of gliomas

Vancomycin versus Linezolid in the Treatment of Methicillin-Resistant Staphylococcus aureus Meningitis

WOS: 000323419000004PubMed ID: 23672240Background: Vancomycin is the mainstay of treatment for methicillin-resistant Staphylococcus aureus (MRSA) meningitis. However, successful outcomes with linezolid have not been reported in a large series of patients. We conducted a single-center retrospective cohort study to compare vancomycin with linezolid in the treatment of MRSA meningitis. Methods: We extracted data and outcomes for all adult patients (age > 18 years) with culture-proved MRSA meningitis who received vancomycin or linezolid between January 2006 and June 2011. A definite diagnosis of meningitis was based on the isolation of MRSA in at least one cerebrospinal fluid (CSF) culture and findings in CSF that are typical of the infection. Linezolid was given intravenously (IV) at a dosage of 600mg q12h and vancomycin IV at 500mg q6h. Results: A total of 8 patients with MRSA meningitis (5 male, 3 female; age [mean +/- SD] 61.6 +/- 13.2 years) received vancomycin and 9 patients (7 male, 2 female; age 59.1 +/- 15.6 years) received linezolid. All isolated strains of MRSA were susceptible to both vancomycin and linezolid. The rates of microbiologic success with linezolid or vancomycin, in terms of clearance of MRSA from CSF on day 5, were 7/9 and 2/8 (p = 0.044, Fisher exact test). No severe adverse events occurred in either treatment arm of the study. One-month survival of the patients in whom treatment was successful microbiologically was 2/2 in the vancomycin-treated group and 4/7 in the linezolid-treated group. Minimum inhibitory concentration (MIC) data for vancomycin were available for 5/6 treatment failures with vancomycin, and vancomycin MIC values of these five strains were 2 mg/L. Conclusion: Analysis of the findings in the limited cohorts in our study suggests that linezolid is superior to vancomycin for treating MRSA meningitis, especially in cases in which there is a high MIC (2mg/L) for vancomycin. A clinical study involving larger cohorts may increase the evidence available in relation to this question