Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter ephesus study

• Published in: BMC Infectious Diseases 2023, Vol.23 (1)
• Main Authors: Sipahi, Oguz Resat, Akyol, Deniz, Ormen, Bahar, Cicek-Senturk, Gonul, Mermer, Sinan, Onal, Ugur, Amer, Fatma, Saed, Maysaa Abdallah, Ozdemir, Kevser, Tukenmez-Tigen, Elif, Oztoprak, Nefise, Altin, Ummugulsum, Kurtaran, Behice, Popescu, Corneliu Petru, Sakci, Mustafa, Suntur, Bedia Mutay, Gautam, Vikas, Sharma, Megha, Kaya, Safak, Akcil, Eren Fatma, Kaya, Selcuk, Turunc, Tuba, Ergen, Pinar, Kandemir, Ozlem, Cesur, Salih, Bardak-Ozcem, Selin, Ozgiray, Erkin, Yurtseven, Taskin, Erdem, Huseyin Aytac, Sipahi, Hilal, Arda, Bilgin, Pullukcu, Hüsnü, Tasbakan, Meltem, Yamazhan, Tansu, Aydemir, Sohret, Ulusoy, Sercan
• Format: Report
• Language: English
• Subjects: Antibacterial agents; Complications and side effects; Cross infection; Dosage and administration; Drug therapy; Meningitis; Nosocomial infections; Patient outcomes; Prevention; Risk factors; Staphylococcal infections
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-023-08596-z

Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p < 0.05). Microbiological success on Day 3-5, end of treatment (EOT) clinical success (80% vs. 54.8%% vs 57.9%), and overall success (EOT success followed by one-month survival without relapse or reinfection 65% vs. 51.6% vs. 45.3%), EOT all cause mortality (ACM) and day 30 ACM (15% vs. 22.6% vs. 26%) did not differ significantly (p > 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci.