Linezolid + rifampisin kombinasyonu ile tedavi edilen metisiline dirençli staphylococcus aureus’un neden olduğu beyin apsesi olgusu
Küçük Resim Yok
Tarih
2010
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info:eu-repo/semantics/openAccess
Özet
Metisiline dirençli Staphylococcus aureus (MRSA), tüm beyin apseleri göz önüne alındığında nispeten nadir bir etken olmakla birlikte, son yıllarda özellikle cerrahi sonrası gelişen beyin apselerinde daha sık gözlenmektedir. Bu olguların antibakteriyel tedavisindeki ilk seçenek vankomisindir. Bu raporda, moksifloksasin + vankomisin ve vankomisin + rifampisin kombinasyonlarına yanıt vermeyen, ancak linezolid + rifampisin ile tedavi edilebilen bir MRSA beyin apsesi olgusu sunulmuştur. Elli bir yaşında kadın hasta subaraknoid kanama ve orta serebral arter bifurkasyon düzeyinde anevrizma nedeniyle ameliyat olduktan 40 gün sonra yara yerinden pürülan akıntı gelişmesi üzerine hastaneye yatırılmıştır. Ateşi olmayan ve nörolojik muayene dahil, fizik muayenesinde patolojik bulgu saptanmayan hastanın bilgisayarlı tomografisinde “supratentorial kesitlerde sağ frontoparietal bölgede kalınlığı yaklaşık 1 cm’ye ulaşan subdural ampiyem ile uyumlu görünüm” saptanması üzerine yara yeri revizyonu amacıyla opere edilmiştir. Ampirik tedavi olarak moksifloksasin başlanan hastanın, ameliyat materyalinde MRSA üremesi üzerine tedaviye vankomisin (4 x 500 mg, IV) eklenmiştir. Konvansiyonel yöntemlerle tanımlanan izolat, disk difüzyon yöntemiyle yapılan antibiyotik duyarlılık testinde, levofloksasin, linezolid, rifampin, vankomisin ve teikoplanine duyarlı bulunmuştur. İki haftalık sürede tedaviye yanıt alınamayan hastada moksifloksasin kesilerek rifampin (300 mg 1 x 2) eklenmiştir. Vankomisin ve rifampin tedavisinin 10. gününde radyolojik olarak serebrit bulgularının da saptanması üzerine vankomisin tedavisi de kesilmiş ve linezolide (2 x 600 mg, IV) geçilmiştir. Tedaviye klinik olarak yanıt veren hastada kontrol tomografilerinde gerileme olması üzerine bu tedavi rejimine altı hafta süreyle devam edilmiştir. Tedavi sırasında herhangi bir hematolojik, böbrek veya karaciğer toksisitesi gelişmemiş; hastanın bir yıllık izlem süresinde ise relaps görülmemiştir. Sonuç olarak olgumuz, vankomisine yanıtsız beyin apsesi olgularında linezolidin alternatif bir tedavi seçeneği olarak kullanılabileceğini düşündürmektedir.
Methicillin-resistant Staphylococcus aureus (MRSA) is a rare cause of cerebral abscesses, however it is a relatively more common etiologic agent in post-neurosurgical abscesses and the main antibacterial therapy option is vancomycin. In this report, a case of brain abscess due to MRSA which did not respond neither to moxifloxacin + vancomycin nor vancomycin + rifampin combination therapies, and merely treated by linezolid + rifampin combination, has been presented. Fifty-one years old female patient who was operated 40 days ago for subarachnoid bleeding and aneurysm in middle cerebral artery bifurcation, was hospitalized due to purulent leakage from the operation area. She did not have fever and her physical examination, including the neurologic system, was normal. Computerized tomography revealed an approximately 1 cm lesion compatible with subdural empyema and cerebral abscess in the right frontoparietal area in supratentorial sections. The patient was operated for wound revision and moxifloxacin was initiated. Since the operation materials revealed MRSA growth, vancomycin (4 x 500 mg, IV) was added to the treatment. The isolate was identified by conventional methods, and antibiotic susceptibility test performed by disk diffusion method showed that it was susceptible to levofloxacin, linezolid, rifampin, vancomycin and teicoplanin. Since no clinical response was obtained in two weeks, moxifloxacin was switched to rifampin (300 mg 1 x 2). On the 10th day of vancomycin + rifampin therapy, radiological findings showed development of cerebritis and therefore vancomycin was changed with line- zolid (2 x 600 mg, IV). The control CT of the patient revealed regression of the brain lesion and linezolid + rifampin treatment continued for six weeks. The patient did not develop any hematological, liver or renal toxicity during the therapy and the radiological findings regressed. No relapse were detected in the one year follow-up period. This case suggested that linezolid might be a treatment alternative in the therapy of vancomycin-refractory MRSA brain abscess.
Methicillin-resistant Staphylococcus aureus (MRSA) is a rare cause of cerebral abscesses, however it is a relatively more common etiologic agent in post-neurosurgical abscesses and the main antibacterial therapy option is vancomycin. In this report, a case of brain abscess due to MRSA which did not respond neither to moxifloxacin + vancomycin nor vancomycin + rifampin combination therapies, and merely treated by linezolid + rifampin combination, has been presented. Fifty-one years old female patient who was operated 40 days ago for subarachnoid bleeding and aneurysm in middle cerebral artery bifurcation, was hospitalized due to purulent leakage from the operation area. She did not have fever and her physical examination, including the neurologic system, was normal. Computerized tomography revealed an approximately 1 cm lesion compatible with subdural empyema and cerebral abscess in the right frontoparietal area in supratentorial sections. The patient was operated for wound revision and moxifloxacin was initiated. Since the operation materials revealed MRSA growth, vancomycin (4 x 500 mg, IV) was added to the treatment. The isolate was identified by conventional methods, and antibiotic susceptibility test performed by disk diffusion method showed that it was susceptible to levofloxacin, linezolid, rifampin, vancomycin and teicoplanin. Since no clinical response was obtained in two weeks, moxifloxacin was switched to rifampin (300 mg 1 x 2). On the 10th day of vancomycin + rifampin therapy, radiological findings showed development of cerebritis and therefore vancomycin was changed with line- zolid (2 x 600 mg, IV). The control CT of the patient revealed regression of the brain lesion and linezolid + rifampin treatment continued for six weeks. The patient did not develop any hematological, liver or renal toxicity during the therapy and the radiological findings regressed. No relapse were detected in the one year follow-up period. This case suggested that linezolid might be a treatment alternative in the therapy of vancomycin-refractory MRSA brain abscess.
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44
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4
