[Adequate intrathecal diffusion of teicoplanin after failure of vancomycin, administered in continuous infusion in three cases of shunt associated meningitis]. / Diffusion intrathécale efficace de la teicoplanine aprés échec de la vancomycine, administrées en perfusion continue, dans trois cas de méningite sur shunt.

Glycopeptides which have excellent in vitro activity against the Gram-positive causal agents of meningitis unfortunately have a poor CSF penetration. Vancomycin distribution into CSF is improved when administered by a continuous intravenous route and staphylococcal shunt related infection have been reported to be cured. Teicoplanin has good in vitro activity against a lot of staphylococci, and activity superior to vancomycin, against streptococci and is less toxic. In three children with shunt ventriculitis (S epidermidis 2, S. faecalis 1) despite a continuous infusion, vancomycin 15 mg/kg over 60 minutes onset, then 50 mg/kg/day was clinically and bacteriologically ineffective with very poor CSF levels even if high blood levels. After failure of vancomycin we used teicoplanin as a continuous i.v. infusion 6 mg/kg over 60 mn onset, then 12 mg/kg/day. This treatment was quickly effective and well tolerated.

[Value of D(-) lactate determination for the fast diagnosis of meningitis after craniotomy. An initial study]. / Intérêt du dosage du D(-) lactate pour le diagnostic rapide de méningite après craniotomie. Etude préliminaire.

The early diagnosis of postoperative bacterial meningitis (BM) may be difficult. CSF cultures may remain sterile. Clinical features and routine laboratory data often fail to give an evidence. As early antibiotic therapy is essential in such patients, a rapid diagnosis is required. Different authors proposed the D(-) isomer of lactic acid as an early and effective marker of infection in the body fluids (including CSF). D(-) lactate is produced by bacteriae and fungi; L(+) lactate may be produced also by human tissues in anaerobic situations. We conducted a prospective study in a neurosurgical intensive care unit to evaluate this technique for the diagnosis of meningitis following craniotomy. Fifty-four patients were included, 40 in group A (not infected or infected out of the CNS), 4 in group B (suspected BM), 10 in group C (BM with positive CSF cultures). No patient suffered from septicemia, haemodynamic or ventilatory instability, nor metabolic disorder. Clinical data, CSF and blood samples (cytology, conventional biochemistry, D(-) and L(+) lactate, bacteriology) were collected at inclusion and, in group B and C patients, at day 2, 5 and at clinical recovery. D(-) lactate measurements were performed with an enzymatic method adaptated from a Boehringer Mannheim kit (for determination in foodstuff). Statistics were based on the comparison of group A vs C patients. D(-) and L(+) lactate concentrations in the CSF were significantly higher in group C patients, and blood concentrations were similar.(ABSTRACT TRUNCATED AT 250 WORDS)