Rifampicin + ceftriaxone versus vancomycin + ceftriaxone in the treatment of penicillin-and cephalosporin-resistant pneumococcal meningitis in an experimental rabbit model

Abstract This study was planned to compare the efficacy of ceftriaxone + vancomycin with ceftriaxone + rifampicin in a rabbit model of penicillin and cephalosporin-resistant Streptococcus pneumoniae meningitis. Meningitis was induced by intracisternal inoculation of S. pneumoniae. After 18 h of incubation, Group 1 was given saline solution (control group), whilst Groups 2 and 3 were given ceftriaxone + vancomycin and ceftriaxone + rifampicin, respectively. Cerebrospinal fluid bacterial concentrations were measured at 0, 2, 12, 14 and 24 h after therapy was initiated. In the control group, bacterial growth was present at all time points, whereas no growth was observed in either the ceftriaxone + vancomycin group or the ceftriaxone + rifampicin group after 2 h of therapy. Ceftriaxone + rifampicin was found to be as effective as ceftriaxone + vancomycin in the treatment of penicillin-resistant S. pneumoniae meningitis in experimental rabbit model

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

Addressing silicone ventriculoperitoneal shunt hypersensitivity with teflon sheets: a case report

Ventriculoperitoneal (VP) shunts, used to treat hydrocephalus, can sometimes cause hypersensitivity reactions to silicone, necessitating repeated surgical interventions. Traditional management involves replacing silicone with alternatives like polyurethane, which have limitations. This study presents a novel approach using Teflon (PTFE) sheets to cover the silicone valve surface. A 22-year-old male with a history of multiple shunt surgeries and wound revisions was admitted for wound dehiscence, suspected to be due to a late hypersensitivity reaction to silicone. The shunt valve and cranial entry point were wrapped in Teflon PTFE felt sheets, and the wound was closed with propylene sutures. The patient was treated with methylprednisolone and discharged after three days. Follow-up showed complete wound healing within a month, and the patient remained revision-free for ten years. This case suggests that Teflon sheets may offer a promising approach for managing silicone hypersensitivity in VP shunts, though further studies are needed to determine its broader applicability

Spinal meningeal melanocytoma

✓ The authors report on two patients with spinal meningeal melanocytoma and review the literature on this lesion. One case is particularly interesting because of the lesion's thoracic intramedullary localization. Meningeal melanocytoma is a benign but locally aggressive lesion and is very rarely associated with spinal localizations. This patient presented with paraparesis. Clinical and radiological examinations suggested the possibility of an intramedullary solid tumor. Thoracic laminectomy, posterior myelotomy, and tumor resection were performed; the mass was totally removed. The patient suffered no additional neurological deficit. During a 3-year follow-up period in which radiotherapy was not performed, the lesion did not recur. Total excision of the tumor is the best therapeutic option.</jats:p

Vancomycin versus linezolid in the treatment of methicillin-resistant Staphylococcus aureus meningitis in an experimental rabbit model

WOS: 000314393900001PubMed ID: 23111752Background: The aim of this study was to compare the antibacterial efficacy of vancomycin and linezolid in a rabbit model of methicillin-resistant Staphylococcus aureus (MRSA) meningitis. Material/Methods: Meningitis was induced by intracisternal inoculation of ATCC 43300 strain. After 16 h incubation time and development of meningitis, the vancomycin group received vancomycin 20 mg/kg every 12 h. The linezolid-10 and linezolid-20 groups received linezolid in 10 and 20 mg/kg dosages every 12 h, respectively. The control group did not receive any antibiotics. Cerebrospinal fluid bacterial counts were measured at the end of 16-h incubation time and at the end of 24-h treatment. Results: Bacterial counts were similar in all groups at 16 h. At the end of treatment the decrease in bacterial counts in the vancomycin group was approximately 2 logs higher than the linezolid-20 group (p>0.05) and approximately 4 logs higher than in the linezolid-10 group (p: 0.037) (Vancomycin group: -2.860 +/- 4.495 versus Linezolid-20: -0.724 +/- 4.360, versus Linezolid-10: 1.39 +/- 3.37). Full or partial bacteriological response was higher in vancomycin versus linezolid-10 (p: 0.01), but not vancomycin versus linezolid-20 or linezolid-10 versus-linezolid-20 groups. Conclusions: Our results suggest that linezolid is not statistically inferior to vancomycin in the treatment of MRSA meningitis in an experimental rabbit model in 20 mg/kg q12 h dosage; however, it is inferior in 10 mg/kg q12 h dosage. Additional data should gathered to confirm these findings in advance of clinical trials to assess efficacy in humans.Ege UniversityEge UniversityEge Universit

OUR EXPERIENCES IN A NEUROSURGICAL OPERATING ROOM DURING THE COVID-19 PANDEMIC

Objective: The COVID-19 pandemic has led to many compulsory alterations at health system. Emergency surgery is an area that is facing the need for many adaptations in health system.We aimed to evaluate the emergency cases accepted the neurosurgery operating room during the pandemic period and to determine the adequacy of the measures we took and if any, our deficiencies. Methods: We examined the 135 patients who were urgently operated in the neurosurgery operating room during the pandemic period (between March 15 and June 1, 2020). Demographic features and the way they applied to our clinic were recorded. Our study includes the results of the PCR tests before and after the surgery, chest x-rays, chest CT findings, laboratory results. The patients were called on the phone and asked whether they were diagnosed with COVID-19 in the postoperative period 1st month. Results: COVID-19 infection was detected in 3 of 135 patients who had an emergency surgery. All three patients with the infection were children. Preoperative PCR tests were carried out in only one of the three positive patients. In the other two patients, postoperative test results were positive. No infection was detected in our anesthesia and surgical personnel in our units period. Conclusion: If we organize our surgery programs with the precautions suggested by the guides, we will ensure the safety of both our patients and healthcare professionals