Management of meningitis caused by multi drug-resistant Acinetobacter baumannii: clinical, microbiological and pharmacokinetic results in a patient treated with colistin methanesulfonate
Main Article Content
Keywords
Bacterial Infection
Abstract
This paper reports on a 71-year-old Caucasian male who underwent neurosurgery for an oligodendroglioma, followed by a cranial-sinus fistula and cerebrospinal fluid rhinorrhea. The clinical course was complicated due to an extensively drug-resistant Acinetobacter baumannii meningitis. The patient was treated with colistin methanesulfonate, intrathecal for 24 days and intravenous for 46 days. In addition, the patient received meropenem and teicoplanin to treat a bacterial aspiration pneumonia, probably caused by methicillin resistant Staphylococcus aureus and multi drug-resistant Klebiesella pneumoniae. Cerebrospinal fluid trough colistin levels resulted above the MIC of A. baumannii. Colistin cerebrospinal fluid accumulation over the treatment period was not reported. Meningitis was cured and A. baumannii eradicated. No side effects from the antimicrobial therapy were observed.
In conclusion, this case highlights the issues in treating infections caused by resistant Gram-negative bacteria and supports previous findings on the efficacy, pharmacokinetic and tolerability of intravenous and intrathecal colistin treatments.
Downloads
Abstract 1351
PDF Downloads 900
HTML Downloads 833
COVER LETTER Downloads 0
References
2. Kim B-N, Peleg AY, Lodise TP, Lipman J, Nation R, Paterson DL. Management of meningitis due to antibiotic-resistant Acinetobacter species. Lancet 2009;9:245-255.
3. Karaiskos I, Galani L, Bazika F, Katsouda E, Ioannidis I, Andreou A, Paskalis H, Giamarellou H. Successful treatment of extensively drug-resistant Acinetobacter baumannii ventricultitis and meningitis with intraventricular colistin after application of a loading dose: a cases series. Intern J Antimicrob Agent 2013;4:480-483.
4. Hara GH, Gould I, Endimiani A, Pardo PR, Daikos G, Hsueh PR, Mehtar S, Petrikko G, Casellas JM, Daciuk L, Paciel D, Novelli A, Saginur R, Pryluka D, Medina J, Savio E. Detection, treatment, and prevention of carbapenemase-producing Enterobacteriaceae: recommendations from an International Working Group. J Chemother 2013; 25:129-140.
5. Daikos GL, Tsaousi S, Tzouvelekis LS, Anyfantis I, Psichogiou M, Agrypoulou A, Stefanou I, Sypsa V, Miriagou V, Nepka M, Georgiadou S, Markogiannakis A, Goukos D, Skoutelis A. C. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother 2014;58:2322-2328.
6. Imberti R, Cusato M, Accetta G, Marinò V, Procaccio F, Del Gaudio A, Iotti GA, Regazzi M. Pharmacokinetics of colistin in cerebrospinal fluid after intraventricular administartion of colistin methanesulfonate. Antimicrob Agent Chemother 2012;56: 4416-4421.
7. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-332.
8. Mencacci A, Leli C, Cardaccia A, Montagna P, Moretti A, Bietolini C, Meucci M, Perito S, Cenci E, Bistoni F. Comparison of conventional culture with SeptiFast real-time PCR for microbial pathogen detection in clinical specimens other than blood. J Med Microbiol 2011;60:1774-1778.
9. Wang MC, Lin WH, Yan JJ, Fang HY, Kuo TH, Tseng CC, Wu JJ. Early identification of microorganisms in blood culture prior to the detection of a positive signal in the BACTEC FX system using matrix-assisted laser desorption/ionization–time of flight mass spectrometry. J Microbiol Immunol Infect 2013; doi:10.1016/j.jmii.2013.10.006.
10. Van de Beek D, Drake JM, Tunkel AR. Nosocomial bacterial meningitis. N Engl J Med 2011;362:146-154.
11. Li J, Milne RW, Nation RL, Turnidge JD, Coulthard K, Johnson DW. A simple method for the assay of colistin in human plasma, using pre-column derivation with 9-fluorenylmethyl chloroformate in solid-phase extraction cartridges and reversed-phase high-performance liquid chromatography. Chromatogr B Biomed Sci Appl. 2001;761:167-175.
12. Chang S-S, Hsieh W-H, Liu T-S, Lee SH, Wang CH, Chou HC, Yeo YH, Tseng CP, Lee CC. Multiplex PCR system for rapid detection of pathogens in patients with presumed sepsis-a systematic review and meta-analysis. PLos ONE 2013;8:e62323-62333.