Linezolid in the treatment of severe central nervous system infections resistant to recommended antimicrobial compounds.
The progressive emergence of antimicrobial-resistant Gram-positive cocci especially in the setting of surgery and intensive care, recommends particular attention in making sound therapeutic choices to overcome both microbial resistances and haemato-encephalic barriers to effective local drug penetration. As in other Western countries, the occurrence of methicillin-resistant Staphylococcus aureus is particularly high also in Italy, especially when high-risk patients and/or settings are involved. In treating post-neurosurgical central nervous system infections (cerebral abscess and meningitis), a key issue is represented by the low cerebrospinal fluid concentration of the two available glycopeptide antibiotics (vancomycin and teicoplanin), usually recommended as first-line therapy of resistant Gram-positive cocci. Recent findings have focused on the possible role of linezolid, an oxazolidinone antibiotic, as a suitable candidate for the treatment of severe brain infection (abscesses) and post-neurosurgical infection, where treatment options and efficacy are significantly limited by the low glycopeptide transfer and the spread of glycopeptide-resistant bacterial strains. Three representative case reports (two brain abscesses and one post-surgical meningitis) are presented and discussed in light of the current literature: in all these cases, salvage linezolid treatment proved resolutory.
Sabbatani
Sergio
S
Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna "Alma Mater Studiorum", S. Orsola Hospital, Bologna, Italy.
Manfredi
Roberto
R
Frank
Giorgio
G
Chiodo
Francesco
F
D000081:Acetamides / Q000627:therapeutic use*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001922:Brain Abscess / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery; D002206:Capnocytophaga / Q000187:drug effects / Q000302:isolation & purification*; D003131:Combined Modality Therapy; D003399:Craniotomy; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D004322:Drainage; D004341:Drug Evaluation; D004351:Drug Resistance; D004830:Epilepsy, Tonic-Clonic / Q000209:etiology; D005625:Frontal Lobe / Q000382:microbiology* / Q000601:surgery; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D000069349:Linezolid; D008297:Male; D008336:Mandibular Diseases / Q000150:complications / Q000382:microbiology; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D008875:Middle Aged; D009837:Oligodendroglioma / Q000150:complications / Q000601:surgery; D010014:Osteolysis / Q000382:microbiology; D023303:Oxazolidinones / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology; D012852:Sinusitis / Q000150:complications / Q000382:microbiology
D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D000069349:Linezolid