Posts filed under ‘Infecciones del SNC’

Intravenous fosfomycin-back to the future. Systematic review and meta-analysis of the clinical literature.

Clin Microbiol Infect. 2016 Dec 9. pii: S1198-743X(16)30610-3

Grabein B1, Graninger W2, Rodríguez Baño J3, Dinh A4, Liesenfeld DB5.

Author information

1 Department of Clinical Microbiology and Hospital Hygiene, Munich University Hospital, Munich, Germany.

2 Institute for Infectiology, Karl Landsteiner Society, Vienna, Austria.

3 Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitarios Virgen Macarena y Virgen del Rocío, Departamento de Medicina, Universidad de Sevilla-IBIS, Sevilla, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.

4 Infectious Disease Unit, R. Poincaré University Hospital, Garches, AP-HP, Versailles Saint Quentin University, Garches, France.

5 InfectoPharm Arzneimittel und Consilium GmbH, Heppenheim, Germany. Electronic address:



We conducted a systematic review and meta-analysis to summarize the clinical evidence and usage patterns of intravenous fosfomycin from its development to the present time.


PubMed, the Cochrane Library and local journals were searched for relevant studies reporting aggregated data of intravenous fosfomycin use in adults and children, with no restrictions regarding study design. Single case reports were excluded. Data were systematically abstracted for all included studies. Clinical and microbiological efficacy from randomized controlled and comparative observational studies were synthesized using meta-analysis to calculate pooled effect sizes.


In all, 128 studies on intravenous fosfomycin in 5527 patients were evaluated. Fosfomycin was predominantly used for sepsis/bacteraemia, urinary tract, respiratory tract, bone and joint, and central nervous system infections. No difference in clinical (OR 1.44, 95% CI 0.96-2.15) or microbiological (OR 1.28, 95% CI 0.82-2.01) efficacy between fosfomycin and other antibiotics was observed in comparative trials. The pooled estimate for resistance development during fosfomycin monotherapy was 3.4% (95% CI 1.8%-5.1%). Fosfomycin showed a favourable safety profile, with generally mild adverse events not requiring discontinuation of treatment. Included studies explored intravenous fosfomycin as an anti-staphylococcal agent in monotherapy and combination therapy, whereas studies from 1990 focused on combination therapy (fosfoymcin + β-lactams or aminoglycosides) for challenging infections frequently caused by multidrug-resistant organisms.


Intravenous fosfomycin can play a vital role in the antibiotic armamentarium, given its long history of effective and safe use. However, well-designed randomized controlled trials are still desired.


May 7, 2017 at 2:55 pm

Cytomegalovirus DNA Detection by Polymerase Chain Reaction in Cerebrospinal Fluid of Infants With Congenital Infection: Associations With Clinical Evaluation at Birth and Implications for Follow-up

Clin Inf Dis May 15, 2017 V.64 N.10


Walter-Alfredo Goycochea-Valdivia; Fernando Baquero-Artigao; Teresa del Rosal; Marie-Antoinette Frick; Pablo Rojo …

Human cytomegalovirus DNA detection in cerebrospinal fluid by polymerase chain reaction has been previously considered a risk factor for hearing loss or neurological sequelae in congenital infection. In the present study, it was not associated with neurological or audiological outcomes.


May 6, 2017 at 3:54 pm

ESCMID guideline: diagnosis and treatment of acute bacterial meningitis

Clinical Microbiology & Infection May 2016 V.22 Suppl 3 S37-62

van de Beek, C. Cabellos, O. Dzupova, S. Esposito, M. Klein, A.T. Kloek, S.L. Leib, B. Mourvillier, C. Ostergaard, P. Pagliano, H.W. Pfister, R.C. Read, O. Resat Sipahi, M.C. Brouwer for the ESCMID Study Group for Infections of the Brain (ESGIB)

Bacterial meningitis is a severe infectious disease of the membranes lining the brain resulting in a high mortality and morbidity throughout the world. In the past decades the epidemiology and treatment strategies for community-acquired bacterial meningitis have significantly changed [[1], [2], [3]]. First, the introduction of conjugate vaccines in Europe resulted in the virtual disappearance of Haemophilus influenzae type b, while conjugate pneumococcal and meningococcal vaccines have substantially reduced the burden of bacterial meningitis [1]. As a result, community-acquired bacterial meningitis has become a disease that currently affects more adults than infants, with its specific complications and treatment options. A second important development is the increasing rate of reduced susceptibility to common antimicrobial agents among strains of Streptococcus pneumoniae (pneumococcus) and Neisseria meningitidis (meningococcus). Large differences in resistance rates in Europe exist, and empiric antibiotic treatment needs to be adjusted according to regional epidemiology. Finally, several adjunctive treatments have been tested in randomized controlled trials, often with conflicting results [3]. These developments leave the physician in need of a clear practical guideline, summarizing the available evidence for diagnostic methods, and antimicrobial and adjunctive treatment in bacterial meningitis. To this end the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) promotes guidelines development in the field of infectious diseases. This guideline project was initiated by the ESCMID Study Group for Infections of the Brain (ESGIB).


April 13, 2017 at 5:05 pm

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis

Clinical Infectious Diseases March 15, 2017 V.64 N.6


Allan R. Tunkel; Rodrigo Hasbun; Adarsh Bhimraj; Karin Byers; Sheldon L. Kaplan

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. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.



April 10, 2017 at 9:23 am

Estimating the burden of invasive and serious fungal disease in the United Kingdom

Journal of Infection January 2017 V.74 N.1

Matthew Pegorie a, David W. Denning b,c,d, *, William Welfare a,d

a Public Health England North West Health Protection Team (Greater Manchester), UK

bNational Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK

c The University of Manchester, Manchester, UK

d Manchester Academic Health Sciences Centre, University of Manchester, UK

Background: The burden of fungal disease in the UK is unknown. Only limited data are systematically collected. We have estimated the annual burden of invasive and serious fungal disease.

Methods: We used several estimation approaches. We searched and assessed published estimates of incidence, prevalence or burden of specific conditions in various high risk groups. Studies with adequate internal and external validity allowed extrapolation to estimate current UK burden. For conditions without adequate published estimates, we sought expert advice.

Results: The UK population in 2011 was 63,182,000 with 18% aged under 15 and 16% over 65. The following annual burden estimates were calculated: invasive candidiasis 5142; Candida peritonitis complicating chronic ambulatory peritoneal dialysis 88; Pneumocystis pneumonia 207e587 cases, invasive aspergillosis (IA), excluding critical care patients 2901e2912, and IA in critical care patients 387e1345 patients, <100 cryptococcal meningitis cases. We estimated 178,000 (50,000e250,000) allergic bronchopulmonary aspergillosis cases in people with asthma, and 873 adults and 278 children with cystic fibrosis. Chronic pulmonary aspergillosis is estimated to affect 3600 patients, based on burden estimates post tuberculosis and in sarcoidosis.

Conclusions: Uncertainty is intrinsic to most burden estimates due to diagnostic limitations, lack of national surveillance systems, few published studies and methodological limitations. The largest uncertainty surrounds IA in critical care patients. Further research is needed to produce a more robust estimate of total burden


March 25, 2017 at 5:40 pm

Incidence and mortality of herpes simplex encephalitis in Denmark: A nationwide registry-based cohort study

Journal of Infection January 2017 V.74 N.1

Laura Krogh Jørgensen a, *, Lars Skov Dalgaard a, Lars Jørgen Østergaard a, Mette Nørgaard b, Trine Hyrup Mogensen a,c

a Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensen Boulevard 99, 8200 Aarhus N, Denmark

b Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle´ 43-45, 8200 Aarhus N, Denmark

cDepartment of Biomedicine, Aarhus University, Vennelyst Blvd. 4, 8000 Aarhus C, Denmark

Objectives: We aimed to investigate the incidence and mortality of herpes simplex encephalitis (HSE) in a nationwide cohort.

Methods: From the Danish National Patient Registry, we identified all adults hospitalised with a first-time diagnosis of HSE in Denmark during 2004e2014. The HSE diagnoses were verified using medical records and microbiological data. Patients were followed for mortality through the Danish Civil Registry System. We estimated age-standardised incidence rates of HSE and 30-day, 60-day, and 1-year cumulative mortality. Furthermore, we assessed whether calendar year, age, gender, level of comorbidity, virus type, and department type was associated with HSE mortality.

Results: We identified a total of 230 cases of HSE. Median age was 60.7 years (interquartile range: 49.3e71.6). The overall incidence rate was 4.64 cases per million population per year (95% confidence interval: 4.06e5.28). The cumulative mortality within 30 days, 60 days, and 1 year of the HSE admission was 8.3%, 11.3%, and 18.6%, respectively. Advanced age and presence of comorbidity were associated with increased 60-day and 1-year mortality.

Conclusions: This nationwide study of verified HSE found a higher incidence than reported in previous nationwide studies. Presence of comorbidity was identified as a novel adverse prognostic factor. Mortality rates following HSE remain high.


March 25, 2017 at 5:38 pm

Adults with suspected central nervous system infection: A prospective study of diagnostic accuracy

Journal of Infection January 2017 V.74 N.1

Ula Khatib, Diederik van de Beek, John A. Lees, Matthijs C. Brouwer

Objectives: To study the diagnostic accuracy of clinical and laboratory features in the diagnosis of central nervous system (CNS) infection and bacterial meningitis.

Methods: We included consecutive adult episodes with suspected CNS infection who underwent cerebrospinal fluid (CSF) examination. The reference standard was the diagnosis classified into five categories: 1) CNS infection; 2) CNS inflammation without infection; 3) other neurological disorder; 4) non-neurological infection; and 5) other systemic disorder.

Results: Between 2012 and 2015, 363 episodes of suspected CNS infection were included. CSF examination showed leucocyte count >5/mm3 in 47% of episodes. Overall, 89 of 363 episodes were categorized as CNS infection (25%; most commonly viral meningitis [7%], bacterial meningitis [7%], and viral encephalitis [4%]), 36 (10%) episodes as CNS inflammatory disorder, 111 (31%) as systemic infection, in 119 (33%) as other neurological disorder, and 8 (2%) as other systemic disorders. Diagnostic accuracy of individual clinical characteristics and blood tests for the diagnosis of CNS infection or bacterial meningitis was low. CSF leucocytosis differentiated best between bacterial meningitis and other diagnoses (area under the curve [AUC] 0.95) or any neurological infection versus other diagnoses (AUC 0.93).

Conclusions: Clinical characteristics fail to differentiate between neurological infections and other diagnoses, and CSF analysis is the main contributor to the final diagnosis.


March 25, 2017 at 5:36 pm

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