Whether the antibiotic regimen in our patient contributed to delayed sterilization of his CSF . The efficacy of meropenem against L. monocytogenes has been proven in animal studies (Thonnings et al., 2016); however, the clinical use of meropenem for meningitis caused by L. monocytogenes is limited; therefore, ampicillin and benzylpenicillin are considered first-line agents (Pagliano et al., 2016). The patient ultimately received meropenem for 27 days, resulting in a cure. 9 Our case also raises the discussion as to whether all immunocompromised patients (regardless of their age) suspected of meningitis should be treated empirically with ampicillin to cover for Listeria. Listeriosis: An Overview. . Listeria monocytogenes was isolated from blood in two cases and from cerebrospinal fluid in three. Journal of Chemotherapy: Vol. Treatment for bacterial meningitis with dexamethasone and monotherapy ceftriaxone was started. Conclusion. Doses of 1 gram may also be administered as an intravenous bolus injection (5 mL to 20 mL) over approximately 3 minutes to 5 minutes. Ampicillin has bactericidal activity against L. monocytogenes, as does meropenem, but there are no comparative studies of their level of clinical efficacy in treatment of meningitis. Some studies found other antibiotics, such as vancomycin, linezolid, quinolones, gentamycin, meropenem, and chloramphenicol, to also be effective against Listeria species in vitro. DO NOT USE. Patients with viral meningitis may have a history of preceding . Meningitis caused by L. monocytogenes was suspected and meropenem (1 g/8 hours) was changed to ampicillin (2 g/6 hours). Described here is the case of a child with aplastic anemia who acquired nosocomial listeriosis and failed to respond to initial meropenem therapy. . Cefotaxime was switched to intravenous meropenem . Cefepime or Ceftazidime (or Meropenem) Add Dexamethasone for recurrent Meningitis. of listeria brain abscess, in order to explore the diagnosis and treatment of Listeria brain abscess, and raise awareness and attention to the disease. Listeria monocytogenes is highly susceptible to meropenem in vitro, but data on the efficacy of meropenem in clinical cases of listeriosis are scarce. Meropenem 2g IV q8 Linezolid and rifampin also active, but experience limited. Among the 14 patients, 2 patients were initially treated with meropenem plus penicillin/ ampicillin; 2 patients with meropenem plus vancomycin; and 1 patient with penicillin plus ceftazidime; however, the remaining 9 patients were . Resolution of fever was not noted after 5 days of therapy with meropenem and, more importantly . 4. Described here is the case of a child with aplastic anemia who acquired nosocomial listeriosis and failed to respond to initial meropenem therapy. ( 34303412, 31402154 ) (2) Ceftriaxone 2 grams IV q12hr. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare . However, the clinical data were insufficient to make strong recommendations for any of these agents in Listeria meningitis. However, it can be aggressive in such subjects and is associated with a high mortality rate. Patients surviving encephalitis or brain abscess often have focal neurological deficits or a seizure disorder . Treatment for bacterial meningitis with dexamethasone and monotherapy ceftriaxone was started. Favorable Response to Combination Linezolid . 2012;37 (8):38-41. New antibiotics, such as fluoroquinolones, could have a role in these circumstances, but clinical data to support this notion are scarce. meningitis patients (p <0.01; see Supplementary material, Table S1). Cefepime or Ceftazidime (or Meropenem) Post-Neurosurgery or CSF Shunt. Bacteremia (without meningitis): use meningitis options x 2wks, unless immunocompromised, in which case longer therapy may be necessary. 38 -Viral and Bacterial Meningitis Speaker: Allan Tunkel, MD 2021 Infectious Disease Board Review, LLC . Again meningitis by Listeria, as in our case, presents with atypical symptoms such as lower incidence of meningeal signs and dyselectrolytemia, [ 5, 6] thus creating a dilemma in diagnosis. Aztreonam OR Ciprofloxacin may be used instead of Cephalosporin. Finally, hydrocephalus should be suspected in patients with meningitis (listeria meningitis in this case) who develop reduced conscious level . should be administered by intravenous infusion over approximately 15 minutes to 30 minutes. Listeria monocytogenes is non-endospore forming, regular, non-branching gram positive bacilli that grows in aerobic and anaerobic conditions. Vanc (trough 15-20) + [Cefepime 2g q8h OR Meropenem 2g q8h] + Ampicillin . 2Las cepas aisladas con valores de CIM por encima del punto de corte sensible son muy raras o no se han notificado . 4. This agent is indicated when ampicillin shows inadequate effect or if the patient has an allergy to ampicillin. Intravenous ampicillin is the treatment of choice, but meropenem represents a valid alternative. In conclusion, meropenem is useful to treat bacterial meningitis caused by L. monocytogenes. According to guidelines of IDSA and ESCMID, meropenem had been listed as an alternative treatment for bacterial meningitis [ [10] , [11] , [12] ]. 1 Listeria species are found throughout the environment, residing in soil, water, sewage, vegetation, wild animal feces, farms, and food-processing facilities. ( 31402154) However, dexamethasone may be continued in all patients with bacterial meningitis, except those with Listeria monocytogenes. If you have bacterial meningitis, you will be treated with one or more antibiotics that target the bacteria causing your infection. Treatment for bacterial meningitis with dexamethasone and monotherapy ceftriaxone was started. Described here is the case of a child with aplastic anemia who acquired nosocomial listeriosis and failed to respond to initial meropenem therapy. Up to 95% of patients with bacterial meningitis have at least two of the four following symptoms: fever, headache, stiff neck, or altered mental status. Meropenem, if susceptible . These levels may be as low as 20 to 30 mg/dL (1.1 to 1.7 mmol/L). The patient was successfully treated with meropenem but required neuro-endoscopic intervention for hydrocephalus. Listeria monocytogenes is highly susceptible to meropenem in vitro, but data on the efficacy of meropenem in clinical cases of listeriosis are scarce. The differential diagnosis . We present a case of meningitis in a penicillin allergic paediatric renal transplant patient from whose cerebrospinal fluid (CSF) Listeria monocytogenes was cultured, despite four days of cefotaxime therapy. The. Background: Pediatric meningitis caused by Listeria monocytogenes is rare and is associated with high mortality . A previously healthy 74-year-old Caucasian man with penicillin allergy was admitted with evolving headache, confusion, fever, and neck stiffness. . The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. Puntos de corte no asociados a especies5 <2 >8. After medication with meropenem was started, the clinical symptoms completely disappeared, and the abnormalities on cerebrospinal fluid examination resolved. Diagnosis is based upon cerebrospinal fluid and blood cultures growing Listeria monocytogenes. Meropenem, sold under the brand name Merrem among others, is an intravenous -lactam antibiotic used to treat a variety of bacterial infections. Vancomycin AND. + Meropenem 2g q8h OR Moxifloxacin 400mg QD [If >50 or immune compromise for Listeria: Bactrim 5mg/kg IV QD div q6-12h] if not on Meropenem Duration: N meningitidis/H flu (7d . Background: Pediatric meningitis caused by Listeria monocytogenes is rare and is associated with high mortality and morbidity. S Thnnings, J D Knudsen, H C Schnheyder, M Sgaard, M Arpi, K O Gradel, C stergaard, Danish Collaborative Bacteraemia Network (DACOBAN) KI, Clinical Epidemiology; The 39 (9), 1267-84. Meropenem - Renal dosing: Creatinine Clearance (mL/min) Dose (dependent on type of infection) Dosing Interval > 50: Recommended dose (2 g meningitis) Every 8 hours > 25-50: Recommended dose: Every 12 hours: 10-25: One-half recommended dose: Every 12 hours < 10: . A previously healthy 74-year-old Caucasian man with penicillin allergy was admitted with evolving headache, confusion, fever, and neck stiffness. CSF glucose levels in the absence of meningitis are > 75% of the serum value measured at the same time. Prompt diagnosis is essential so that adequate antibiotic treatment can be started and the best outcome achieved. 10 reduction in cell counts within 12 hours to 24 hours) are typically 1 to 2 times the bacteriostatic concentrations of Meropenem, with the exception of Listeria monocytogenes, against which lethal activity is not observed. If Listeria present: cephalosporins are not effective. These antibiotics commonly include: Cephalosporin antibiotics . Favorable Response to Combination Linezolid-Meropenem Treatment. We describe an unusual case of meningitis by Listeria monocytogenes (LM) complicated by hydrocephalus in a child with dermatomyositis. Clin Infect Dis. A very infrequent report of Listeria monocytogenes meningitis and multiple subtentorial abscesses (cerebellar, bulbar, and pontine in location), occurred in an immunocompetent man, and is described and discussed on the ground of the most recent literature evidences regarding the frequency, presentation, and outcome of this disease. To the best of our knowledge, this is the first case of Listeria meningitis related to mantle cell lymphoma treated successfully with meropenem reported in China. Furthermore, on pure theoretical grounds meropenem has a slightly broader spectrum and covers for Listeria [10,17, 18], although there is limited clinical experience, since Listeria is a . for Listeria monocytogenes , as add-on drug to the backbone treatment with a third-generation cephalosporin []. 331-333. Although Listeria monocytogenes is an uncommon cause of meningitis beyond the neonatal period, . Meropenem had excellent activity against Listeria in vitro tests and may have an effect on the treatment of Listeria infection according to research reported . In conclusion, meropenem is useful to treat bacterial meningitis caused by L. monocytogenes. Streptococcus species (incl some Enterococci), Listeria, H. flu, E. coli Proteus mirabilis, Salmonella, Shigella DO NOT USE IF PENICILLINASE PRODUCING Combinations with beta-lactamase inhibitors: Non anti-pseudomonal Amoxicillin plus clavulanate (po - Augmentin) Extends H. flu and Staph coverage Ampicillin plus sulbactam (IV - Unasyn) Our guidelines did not cover for LM meningitis in cases with penicillinallergyin, whenourcaseoccurred.Inthe new national Danish guidelines for bacterial meningitis, meropenem is recommended for patients with penicillin meropenem (Merrem IV . Streptococcus agalactiae (group B streptococcus), Listeria monocytogenes, . Practice Guidelines for the Management of Bacterial Meningitis. Listeria meningitis is rarely reported in previously healthy children with no immunological disorders. Treatment consisted of ampicillin in all cases with the addition of tobramycin (1), TMPS (1), meropenem (2) or imipenem/cilastatin (1). Bacterial meningitis has been identified by culture in neonates with normal CSF indices, showing that normal CSF values do not exclude a diagnosis of meningitis. . Cases four and five were diagnosed in one male and one female renal recipient. Meropenem concentrations in the CSF of children with meningitis are approximately 20 % of concurrent plasma levels although there is significant inter- individual variability. Meropenem is active in vitro and is approved for the treatment of bacterial meningitis. meropenem were started and penicillin suspended. Not active/clinical failures associated with cephalosporins, vancomcyin, quinolones, tetracyclines. (2006). This was the first case of neonatal Listeria meningitis in our country and it was presented to withdraw attention to L.monocytogenes serotype 1/2b which was a rare cause of late . Some of these include meningitis, intra-abdominal infection, pneumonia, sepsis, and anthrax.. Common side effects include nausea, diarrhea, constipation, headache, rash, and pain at the site of injection. The initial treat-ment with vancomycin and ceftriaxone, substituted on day 4 with meropenem, did not produce any clinical effect. due to the patient's repeated fever during hospitalization. meropenem, and aztreonam in patients with renal dysfunction *These guidelines are not intended for use in neonatal patients who have been hospitalized beyond the initial postpartum time period. Listeria monocytogenes <0,25 >0,25. There was an increase of infectious parameters and ventilatory, To report a clinical case of a newborn with sepsis and meningitis inotropic and transfusional support were necessary. Routine culture media are effective for isolating L . The patient ultimately received meropenem for 27 days, resulting in a cure. After medication with meropenem was started, the clinical symptoms completely disappeared, and the abnormalities on cerebrospinal fluid examination resolved. Microbiological diagnosis is important as L. monocytogenes is inherently resistant to cephalosporin and vancomycin commonly used as an empiric regimen for . Request PDF | On Jul 1, 2006, R Manfredi and others published Listeria monocytogenes Meningitis and Multiple Brain Abscesses in an Immunocompetent Host. The empirical treatment initiated with vancomycin and meropenem was changed to ampicillin and gentamicin and clinical and microbiological response was obtained. In the 51 cases of Listeria meningitis examined, we found that the 30-day mortality of patients treated with meropenem (17%) was similar to the level seen with . Empiric Antibiotic Treatment of Bacterial Meningitis Adults < 50 - Vanc . In conclusion, meropenem is useful to treat bacterial meningitis caused by L. monocytogenes. 2.2 Use in Adult Patients with Renal Impairment. Other symptoms can include nausea, vomiting, photalgia (photophobia), sleepiness, confusion, irritability, delirium, and coma. Bacterial Meningitis. Reference: Tunkel AR et al. Because L. monocytogenes meningitis in children from Southwest China has rarely been reported, we aimed to summarize the clinical data of pediatric L. monocytogenes meningitis cases encountered at our hospital to improve disease diagnosis and treatment. 2004. Meropenem is recommended for treatment of neonatal meningitis that is caused by MDR Gram-negative organisms, although it is approved for use only in infants aged older than 3 months for bacterial meningitis or complicated intra-abdominal infections due to limited data on meropenem use in neonates [97, 102]. Patient concerns: A 64-years-old female patient presented to our institution with 4 days of right arm and leg weakness, the salient past history of the patient was nephrotic syndrome, membranous nephropathy diagnosed 6 months prior, for which . The patient ultimately received meropenem for 27 days, resulting in a cure. Mortality Atotalof61outof229patients(26.6%)diedwithin30daysafter diagnosis, and 31 of these patients died while receiving empirical antibiotic treatment. 1Los puntos de corte de Meropenem paraStreptococcus pneumoniaeyHaemophilus influenzaeen meningitis son 0,25 mg/l (Sensible) y 1 mg/l (Resistente). Cherubin CE, Marr JS, Sierra MF, Becker S. Listeria and gram-negative bacillary meningitis in New York City, 1972-1979: frequent causes of meningitis in adults. 18, No. In community-acquired meningitis patients, Klebsiella pneumoniae (25.6%) was the most common isolate, followed by Streptococcus pneumoniae (18.6%) and Listeria monocytogenes (11.6%). The cerebrospinal fluid showed negative microscopy for bacteria, no bacterial growth, and negative polymerase chain reaction for bacterial DNA. It is a cause of meningitis, encephalitis, brain abscesses, bacteremia/septicemia, lymphadenitis, empyema, myocarditis, endocarditis (native/prosthetic valves), and septic arthritis (especially if rheumatoid arthritis) in . After switching the antibiotics, her AMS gradually resolved. In severe Penicillin / Cephalosporin allergy. Definitive antibiotic treatment with benzylpenicillin or aminopenicillin resulted in a lower 30-day mortality in an adjusted analysis compared with meropenem (OR 0.3; 95% CI 0.1-0.8). The incidence of bacterial meningitis in infants and children has decreased since the routine use of conjugated vaccines targeting Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis. Meropenem has good in vitro activity against L monocytogenes, but data on the efficacy of meropenem in clinical cases of listeriosis are scarce . Treatment. Meropenem for injection (I.V.) US Pharm. cadd ampicillin if Listeria is suspected 29 Predisposing Condition Antimicrobial Therapy Immunocompromise Vancomycin + ampicillin + either meropenem or cefepime Basilar skull fracture Vancomycin + a third generation Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. Gram positive bacilli regular short (singly or short chains) (facultative anaerobic) . Listeria monocytogenes is a small, facultative anaerobic, nonsporulating, gram-positive rod.It grows best at temperatures of 30 to 37C, but it grows well at colder (refrigerator) temperatures, and in the laboratory can be separated from other bacteria by taking advantage of this fact, a technique known as cold enrichment ().). A clinical pharmacist adjusted repeatedly the patient's anti-infective therapeutic regimen by analyzing the pharmacologic and pharmacokinetic characteristics of antibacterial drugs (such as cefotaxime, meropenem, etc.) In patients with HIV infection, non-bacterial causes of meningitis must be considered, particularly cryptococcal . Use of Meropenem for Injection, . tially treated bacterial meningitis was made. Meropenem, vancomycin . Thus, meropenem is active against the three major pathogens causing bacterial meningitis (Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis), as well as against Enterobacteriaceae and Listeria monocytogenes (MIC 90 0.25 mg/L). accounts for 20-65% of all deaths in the USA from foodborne . Meningitis is an inflammatory process involving the meninges. The pharmacokinetics of meropenem in neonates requiring anti-infective treatment showed greater clearance in neonates with higher chronological or gestational age with an . Infections caused by Haemophilus influenzae, Neisseria meningitidis, three strains of Streptococcus pneumoniae (two penicillin-resistant), Escherichia coli, Pseudomonas aeruginosa and Listeria monocytogenes all responded to meropenem, which was as active as the comparator agents in all studies, and was more active in most. Listeria monocytogenes Gram Stain. However, on the 15th day of admission, her systolic blood pressure dropped to 70 mm Hg and she developed septic shock once again. Listeriosis may resemble influenza or gastroenteritis but can be fatal and often occurs in outbreaks affecting the immunocompromised especially. 2 Infections, which are usually the result of . 3, pp. There was no signicant difference in 30-day mortality between bacteraemia and meningitis cases (27% versus 25%, p 0.7). Blood cultures tend to be of higher yield (approximately 70%) than cerebrospinal fluid (CSF) cultures (approximately 40% in meningoencephalitis and anywhere from zero to twenty percent in abscess/cerebritis) [ 8, 9 ]. On day 6 Listeria monocytogenes was isolated and, even as late as that, the administration of ampicillin was followed by complete re-covery of the patient. Listeria meningitis may lead to obstructive hydrocephalus. In conclusion, inadequate empiric antibiotic therapy and definitive therapy with meropenem were both associated with significantly higher 30-day mortality. Ertapenem is considerably less active than meropenem and should not be used. Bacterial meningitis kills or maims about a fifth of people with the disease. The patient . The meningitis UK guidelines suggest prescribing ampicillin for all patients with suspected meningitis above the age of 55 years to cover for Listeria. Publication types Meropenem Infected Shunt S. aureus, CoNS, P. acnes, gram-negatives (rare) Vancomycin PLUS Cefepime Vancomycin PLUS Meropenem Immunocompromised is defined as HIV or AIDS, receipt of immunosuppressive therapy, or after transplantation. After medication with meropenem was started, the clinical symptoms completely disappeared, and the abnormalities on cerebrospinal fluid examination resolved. Listeriosis is a serious, potentially fatal infection caused by Listeria species. Serious side effects include Clostridioides . N.meningitidis confirmed : Antibiotic treatment and mortality in patients with Listeria monocytogenes meningitis or bacteraemia. This antibacterial spectrum means that meropenem is two- to fourfold more active than imipenem against Gram-negative pathogens but has only about half the activity against Gram-positive bacteria. Some studies found other antibiotics, such as vancomycin, linezolid, quinolones, gentamycin, meropenem, and chloramphenicol, to also be effective against Listeria species in vitro. Additionally . Vancomycin and caused by Listeria. However, the clinical data were insufficient to make strong recommendations for any of these agents in Listeria meningitis. AB - Introduction:Listeria monocytogenes, a common cause of bacterial meningitis, rarely involves the central nervous system (CNS) in the form of multiple cerebral ring-enhancing lesions. . Am J Med 1981 ;71: 199 - 209 Crossref Dexamethasone is supported best in meningitis due to Streptococcus pneumoniae or Haemophilus influenzae. Meropenem as monotherapy has been found to be active in experimental meningitis caused by L monocytogenes. Listeria monocytogenes is highly susceptible to meropenem in vitro, but data on the efficacy of meropenem in clinical cases of listeriosis are scarce. Listeria monocytogenes Meningitis and Multiple Brain Abscesses in an Immunocompetent Host.