辅助使用达托霉素比利福平更能有效减轻婴儿大鼠肺炎球菌性脑膜炎的脑损伤和听力损失。
Adjunctive daptomycin attenuates brain damage and hearing loss more efficiently than rifampin in infant rat pneumococcal meningitis.
机构信息
Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Switzerland.
出版信息
Antimicrob Agents Chemother. 2012 Aug;56(8):4289-95. doi: 10.1128/AAC.00674-12. Epub 2012 May 29.
Exacerbation of cerebrospinal fluid (CSF) inflammation in response to bacteriolysis by beta-lactam antibiotics contributes to brain damage and neurological sequelae in bacterial meningitis. Daptomycin, a nonlytic antibiotic acting on Gram-positive bacteria, lessens inflammation and brain injury compared to ceftriaxone. With a view to a clinical application for pediatric bacterial meningitis, we investigated the effect of combining daptomycin or rifampin with ceftriaxone in an infant rat pneumococcal meningitis model. Eleven-day-old Wistar rats with pneumococcal meningitis were randomized to treatment starting at 18 h after infection with (i) ceftriaxone (100 mg/kg of body weight, subcutaneously [s.c.], twice a day [b.i.d.]), (ii) daptomycin (10 mg/kg, s.c., daily) followed 15 min later by ceftriaxone, or (iii) rifampin (20 mg/kg, intraperitoneally [i.p.], b.i.d.) followed 15 min later by ceftriaxone. CSF was sampled at 6 and 22 h after the initiation of therapy and was assessed for concentrations of defined chemokines and cytokines. Brain damage was quantified by histomorphometry at 40 h after infection and hearing loss was assessed at 3 weeks after infection. Daptomycin plus ceftriaxone versus ceftriaxone significantly (P < 0.04) lowered CSF concentrations of monocyte chemoattractant protein 1 (MCP-1), MIP-1α, and interleukin 6 (IL-6) at 6 h and MIP-1α, IL-6, and IL-10 at 22 h after initiation of therapy, led to significantly (P < 0.01) less apoptosis, and significantly (P < 0.01) improved hearing capacity. While rifampin plus ceftriaxone versus ceftriaxone also led to lower CSF inflammation (P < 0.02 for IL-6 at 6 h), it had no significant effect on apoptosis and hearing capacity. Adjuvant daptomycin could therefore offer added benefits for the treatment of pediatric pneumococcal meningitis.
β-内酰胺类抗生素引起的脑脊液(CSF)炎症加剧有助于细菌性脑膜炎的脑损伤和神经后遗症。与头孢曲松相比,不裂解抗生素达托霉素作用于革兰氏阳性菌,可减轻炎症和脑损伤。为了将其应用于小儿细菌性脑膜炎的临床治疗,我们研究了达托霉素或利福平与头孢曲松联合应用于婴儿大鼠肺炎球菌性脑膜炎模型的效果。将 11 日龄 Wistar 大鼠感染肺炎球菌性脑膜炎后 18 小时随机分为治疗组:(i)头孢曲松(100mg/kg,皮下[sc],每天两次[b.i.d.]),(ii)达托霉素(10mg/kg,sc,每天一次),15 分钟后再给予头孢曲松,或(iii)利福平(20mg/kg,腹腔内[i.p.],每天两次[b.i.d.]),15 分钟后再给予头孢曲松。在治疗开始后 6 和 22 小时采集脑脊液,并评估特定趋化因子和细胞因子的浓度。感染后 40 小时通过组织形态计量法评估脑损伤,感染后 3 周评估听力损失。达托霉素加头孢曲松与头孢曲松相比,在治疗开始后 6 小时显著降低了脑脊液中单核细胞趋化蛋白 1(MCP-1)、MIP-1α 和白细胞介素 6(IL-6)的浓度(P < 0.04),在 22 小时时显著降低了 MIP-1α、IL-6 和 IL-10 的浓度(P < 0.01),并显著减少了细胞凋亡(P < 0.01),显著改善了听力能力。虽然利福平加头孢曲松与头孢曲松相比,也降低了 CSF 炎症(6 小时时 IL-6 降低,P < 0.02),但对细胞凋亡和听力能力无显著影响。因此,辅助达托霉素可能为小儿肺炎球菌性脑膜炎的治疗带来额外的益处。