From the Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut.
Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Pediatr Infect Dis J. 2024 Jul 1;43(7):663-668. doi: 10.1097/INF.0000000000004310. Epub 2024 Mar 4.
Managing health care acquired and device-associated intracranial infections in young children can be challenging given adverse antibiotic side effects and difficulties in achieving adequate central nervous system (CNS) antibiotic concentrations. Ceftaroline is a cephalosporin with a favorable safety profile and activity against methicillin-resistant Staphylococci and several Gram-negative organisms. Published data on the use of ceftaroline for CNS infections in children and adults are limited.
We describe a 2-month-old infant with ventriculo-subgaleal shunt-associated methicillin-resistant Staphylococcus epidermidis ventriculitis, which was successfully treated with ceftaroline, in addition to vancomycin and rifampin. We conducted a scoping review of English-language literature retrieved from PubMed, EMBASE and Web of Science that assessed the use of ceftaroline for CNS infections.
We identified 22 articles for inclusion in our review, which described 92 unique patients, of whom 2 were <21 years old. Ceftaroline was commonly used in conjunction with other antibiotics to treat infections caused by Staphylococcus aureus , coagulase-negative Staphylococci and Streptococcus pneumoniae . Most case reports described clinical success with ceftaroline, though small case series and cohort studies yielded mixed efficacy assessments. Adverse effects attributed to ceftaroline were rare and included reversible myelosuppression, eosinophilia, hepatotoxicity and nephrotoxicity. Pharmacokinetic/pharmacodynamic studies suggested similar CNS penetration through inflamed meninges as other beta lactam antibiotics.
We identified a growing body of published evidence supporting the use of ceftaroline in combination with other agents for the treatment of CNS infections. In absence of clinical trials, additional real-world data are needed to define the efficacy and safety of ceftaroline for children and adults with CNS infections.
由于抗生素的不良反应以及难以达到足够的中枢神经系统（CNS）抗生素浓度，管理婴幼儿获得性和器械相关的颅内感染可能具有挑战性。头孢洛林是一种头孢菌素，具有良好的安全性，对耐甲氧西林金黄色葡萄球菌和几种革兰氏阴性菌具有活性。关于头孢洛林在儿童和成人中枢神经系统感染中的应用的已发表数据有限。
我们描述了一例 2 个月大的婴儿，患有与脑室下颅骨分流相关的耐甲氧西林表皮葡萄球菌脑室炎，除万古霉素和利福平外，还成功使用头孢洛林进行治疗。我们对从 PubMed、EMBASE 和 Web of Science 检索到的英语文献进行了范围综述，评估了头孢洛林在 CNS 感染中的应用。
我们确定了 22 篇文章纳入我们的综述，其中描述了 92 例独特的患者，其中 2 例<21 岁。头孢洛林通常与其他抗生素联合用于治疗由金黄色葡萄球菌、凝固酶阴性葡萄球菌和肺炎链球菌引起的感染。大多数病例报告描述了头孢洛林的临床成功，但小型病例系列和队列研究得出了混合的疗效评估。归因于头孢洛林的不良反应罕见，包括可逆性骨髓抑制、嗜酸性粒细胞增多、肝毒性和肾毒性。药代动力学/药效学研究表明，通过炎症脑膜，头孢洛林的中枢神经系统穿透与其他β-内酰胺类抗生素相似。
我们发现越来越多的已发表证据支持头孢洛林与其他药物联合用于治疗 CNS 感染。在没有临床试验的情况下，需要更多的真实世界数据来定义头孢洛林在儿童和成人 CNS 感染中的疗效和安全性。
