The following is a summary of “Empiric treatment of healthcare-associated central nervous system infections in Denmark: do we need carbapenems?,” published in the February 2024 issue of Infectious Diseases by Kraef et al.
Carbapenems are commonly employed in empirical therapy for healthcare-related central nervous system (CNS) infections.
Researchers conducted a retrospective study to explore the viability of a carbapenem-sparing approach, incorporating third-generation cephalosporins (ceftriaxone or cefotaxime) along with vancomycin, for empirically treating healthcare-related CNS infections in Eastern Denmark.
They examined local microbiological records (from January 1, 2020, to August 31, 2022) to pinpoint microorganisms resistant to third-generation cephalosporins and scrutinized all carbapenem prescriptions over a three-month duration to evaluate their purpose—the rationale at the neurosurgery and neuro-intensive care departments at Copenhagen University Hospital Rigshospitalet.
The results showed that of 25,247 bacterial cultures identified, 2,563 CNS-related samples were included for analysis. Among these, the positivity rate was 10.5% (n = 257/2439) for cerebrospinal fluid and 75.8% (n = 95/124) for brain parenchyma. Five individual patients’ CNS samples revealed bacteria resistant to third-generation cephalosporins (Enterobacter spp. (n = 3), Pseudomonas spp. (n = 2), Klebsiella spp. (n = 2), Citrobacter freundii (n = 1)), all hospitalized for ≥10 days at antibiotic initiation. Among 11,626 blood culture sets, 10 patients had Gram-negative bloodstream infections resistant to ceftriaxone and piperacillin/tazobactam. 140 days of carbapenem therapy (32%) in 18 patients (36%) were definitely or possibly indicated per guidelines, none for healthcare-associated CNS infections.
Investigators concluded that third-generation cephalosporins are sufficient for most healthcare-associated CNS infections but consider carbapenems for high-risk patients (prolonged stay, immunosuppressed, prior antibiotic use, resistant bacteria).
Source: tandfonline.com/doi/full/10.1080/23744235.2024.2315478