Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Vankomisin Dirençli Enterokok ile Oluşturulmuş Deneysel Menenjit Modelinde Daptomisin ve Linezolidin Etkinliklerinin Karşılaştırılması
Efficacy of Daptomisin Versus Linezolid in the Treatment of Vancomycin Resistant Enterococcus Meningitis in an Experimental Rabbit Model
Sema SARIa, Ediz TÜTÜNCÜb , İrem Gül SANCAKc , İrfan ŞENCANb
a Niğde Ömer Halisdemir Üniversitesi Eğitim ve Araştırma Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji (Erişkin) ABD, Yoğun Bakım BD, Niğde, Türkiye
bDışkapı Yıldırım Beyazıt Eğitim Araştırma ve Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, Ankara, Türkiye
c Ankara Üniversitesi Veteriner Fakültesi, Cerrahi ABD, Ankara, Türkiye
Turkiye Klinikleri J Med Sci. 2023;43(3):261-8
doi: 10.5336/medsci.2022-92253
Article Language: TR
Full Text
ÖZET
 Amaç: Akut bakteriyel menenjitlerin yüksek mortalite ve morbidite oranları ile acil tedavi endikasyonları olup uygun tedavi, uygun dozda ve uygun sürede verilmelidir. Vankomisin dirençli enterokok [vancomycin resistant enterococcus (VRE)] taşıyıcılığı giderek artan oranlarda görülmeye başlanmıştır ve postoperatif menenjit etkeni olarak da karşımıza çıkmaktadır. Ancak VRE menenjitinde optimal tedavi rejimi bulunmayıp, vaka bazında değerlendirilmektedir. Bu çalışmada, deneysel menenjit modelinden yola çıkılarak VRE menenjitinde tedavi planı oluşturulmasına katkı sağlanması amaçlanmıştır. Gereç ve Yöntemler: Çalışmamızda Yeni Zelanda tavşanlarında VRE menenjit modeli oluşturulduktan sonra daptomisin ve linezolidin etkinliği kontrol grubu ile karşılaştırılmıştır. Daptomisin 15 mg/kg tek doz, linezolid 20 mg/kg dozunda 12 saat arayla 2 doz olarak uygulanmıştır. Kontrol grubuna antibiyotik verilmemiştir. Gruplar, beyin omurilik sıvısı (BOS) hücre sayımı, kültür, protein, glikoz ve eş zamanlı kan şekerleri açısından karşılaştırılmıştır. Bulgular: BOS pleositozu ve biyokimyasında her iki grupta benzer gerilemeler olmakla birlikte tedavinin 24. saatinde daptomisin grubunda tavşanların %22'sinde üreme devam ederken, linezolid ve kontrol grubunda üreme olmamıştır. Sonuç: Çalışmamızda daptomisin ve linezolid grubu arasında istatistiksel olarak anlamlı fark saptanmamıştır. VRE menenjiti için yerleşik bir tedavi rejimi olmaması nedeniyle çalışmamızdaki antibiyotiklerin etkinliğinin standart rejimle kıyaslanması imkânı olmamıştır. Mevcut bulgularla önerilebilecek optimal bir tedavi rejimi bulunmamaktadır. Yeni tedavi seçenekleri, kombinasyon tedavileri ya da intratekal, intraventriküler uygulamalar üzerine ileri araştırmalar yapılması gerekmektedir.

Anahtar Kelimeler: Menenjit; vankomisin dirençli enterokok; linezolid; daptomisin
ABSTRACT
 Objective: Acute bacterial meningitis, which has a high rate of mortality and morbidity, has emergency therapy indication. Optimal therapy must be applied at optimal duration and optimal dosage. Carriage of vancomycin resistant enterococcus (VRE) are increasingly seen and we see VRE as the cause of postoperative meningitis. However, in VRE meningitis, there is no optimal treatment regimen and the disease is evaluated on a case-by-case basis. In this study, it is aimed to contribute to a treatment plan for VRE meningitis based on the experimental meningitis model. Material and Methods: In our study, after creating a VRE experimental meningitis model, daptomycin and linezolid activity was compared with control group. Daptomycin was given 15 mg/kg at one dose, linezolid was given 20 mg/kg at 2 doses every 12 hours. Groups were compared with each other for cerebrospinal fluid (CSF) cell count, culture, protein, glucose, simultaneous blood glucose. Results: In both groups, CSF pleocytosis and biochemical response were similar. In the daptomycin group 24th hour of the treatment, CSF culture was positive in 22% of the rabbits, whereas no growth was observed in linezolid and control groups. Conclusion: As a result, there is no statistically significant difference observed between daptomycin and linezolid groups. There is not a standard treatment regimen for VRE meningitis, so we couldn't compare the antibiotics that we use in our study with the standard regimen. Due to the lack of an established treatment regimen for VRE meningitis, it was not possible to compare the efficacy of antibiotics in our study with the standard regimen. Further research should be conducted on new antibiotics, combination therapies and intrathecal-intraventricular practices.

Keywords: Meningitis; vancomycin resistant enterococcus; linezolid; daptomycin
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