Cure of multiresistant Acinetobacter baumannii central nervous system infections with intraventricular or intrathecal colistin: case series and literature review

Objectives: CNS infections due to multiresistant Acinetobacter baumannii (MRAB) are an emerging problem in neurosurgical patients. Colistin remains one of the few remaining treatment options for MRAB but has poor CNS penetration. We describe our experience with intraventricular or intrathecal colist...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy 2006-11, Vol.58 (5), p.1078-1081
Main Authors: Ng, John, Gosbell, Iain B., Kelly, John A., Boyle, Michael J., Ferguson, John K.
Format: Article
Language:English
Subjects:
A. baumannii
Acinetobacter baumannii
Acinetobacter baumannii - isolation & purification
Acinetobacter Infections - drug therapy
Acinetobacter Infections - microbiology
Adult
Aged
Anti-Bacterial Agents - administration & dosage
Antibiotics. Antiinfectious agents. Antiparasitic agents
Biological and medical sciences
Central Nervous System Bacterial Infections - drug therapy
Central Nervous System Bacterial Infections - microbiology
Chemotherapy
Child, Preschool
CNS infections
Colistin - administration & dosage
Drug Resistance
Drug therapy
Female
Humans
Infections
injections
Injections, Intraventricular
Injections, Spinal
Male
Medical sciences
meningitis
Microbiology
Middle Aged
Neurosurgery
Pharmacology
Pharmacology. Drug treatments
polymyxin E
ventriculitis
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Summary:Objectives: CNS infections due to multiresistant Acinetobacter baumannii (MRAB) are an emerging problem in neurosurgical patients. Colistin remains one of the few remaining treatment options for MRAB but has poor CNS penetration. We describe our experience with intraventricular or intrathecal colistin for this infection. Methods: Cases known to have received intraventricular or intrathecal colistin for CNS infections due to MRAB were retrospectively reviewed regarding colistin treatment, colistin efficacy and adverse events. Results: Five patients were identified. All were admissions to the neurosurgical ICU and all were cured of their CNS infections. Three cases were complicated by drug-induced aseptic meningitis or ventriculitis. Conclusions: This largest case series to date shows that direct instillation of colistin into the CNS may cause chemical meningitis or ventriculitis but it is an effective treatment option for MRAB CNS infection. Further study of dosing regimens is needed.
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkl347