RESUMO
BACKGROUND: Evidence for the effectiveness of linezolid in neurosurgical infections (NSIs) is growing. The comfortable oral dosage and tolerance of linezolid opens the possibility for sequential antimicrobial treatment (SAT) in stable patients after a period of intravenous treatment. METHODS: To evaluate the efficacy and safety of SAT with oral linezolid in patients with NSI and to analyse the cost implications, an observational, non-comparative, prospective cohort study was conducted on clinically stable consecutive adult patients at the Neurosurgical Service. Following intravenous treatment, patients were discharged with SAT with oral linezolid. RESULTS: A total of 77 patients were included. The most common NSIs were: 41 surgical wound infections, 20 subdural empyemas, 18 epidural abscesses, and 16 brain abscesses. Forty-four percent of patients presented two or more concomitant NSIs. Aetiological agents commonly isolated were: Propionibacterium acnes (36 %), Staphylococcus aureus (23 %), Staphylococcus epidermidis (21 %) and Streptococcus spp. (13 %). The median duration of the SAT was 15 days (range, 3-42). The SAT was interrupted in five cases due to adverse events. The remainder of the patients were cured at the end of the SAT. A total of 1,163 days of hospitalisation were saved. An overall cost reduction of 516,188 was attributed to the SAT. Eight patients with device infections did not require removal of the device, with an additional cost reduction of 190,595. The mean cost saving per patient was 9,179. CONCLUSIONS: SAT with linezolid was safe and effective for the treatment of NSI. SAT reduces hospitalisation times, which means significant savings of health and economic resources.
Assuntos
Antibacterianos/efeitos adversos , Custos e Análise de Custo , Linezolida/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/economia , Feminino , Humanos , Linezolida/administração & dosagem , Linezolida/economia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Infecção da Ferida Cirúrgica/tratamento farmacológicoRESUMO
Described here is a case of meningitis caused by multidrug-resistant Acinetobacter baumannii susceptible only to colistin, which was treated successfully with intravenous colistin sulfomethate sodium (5 mg/kg/day). The levels of colistin in serum and cerebrospinal fluid and the pharmacokinetic/pharmacodynamic parameters of colistin were determined. In this case, intravenously administered colistin penetrated cerebrospinal fluid (25% of serum levels) at levels sustaining bactericidal concentrations.
Assuntos
Acinetobacter/efeitos dos fármacos , Colistina/líquido cefalorraquidiano , Colistina/farmacocinética , Resistência a Múltiplos Medicamentos , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologia , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Adolescente , Antibacterianos/sangue , Antibacterianos/líquido cefalorraquidiano , Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Colistina/sangue , Colistina/uso terapêutico , Humanos , Injeções Intravenosas , Masculino , Testes de Sensibilidade MicrobianaRESUMO
A case of successful treatment of orbital echinococcosis without evidence of recurrence on prolonged follow-up is presented. The management of orbital hydatid cyst is discussed. ¿ 2000 The British Infection Society
