colistin and Brain-Abscess

The treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3 rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient's treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41 st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68 th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Carbapenem-Resistant Enterobacteriaceae; Colistin; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Meropenem; Microbial Sensitivity Tests; Tigecycline

We report a case of post-neurosurgical meningitis, subdural empyema, and cerebral abscess caused by multidrug-resistant Acinetobacter baumannii (MRAB) poorly susceptible to colistin. A 49-year-old man was transferred to our hospital after surgical treatment for putaminal hemorrhage in a foreign country hospital. Several examinations revealed surgical site infection (SSI). From cerebro-spinal fluid examination via ventricular drainage, MRAB was recovered. The minimum inhibitory concentration (MIC) of colistin was 2 µg/mL. Intravenous administration of colistin with ceftazidime and rifampicin was started, with intrathecal colistin administration, based on the results of a Break-point Checkerboard examination, and resulted in effective infection control. Nosocomial infection by MRAB has become an emergent problem in many countries. In Japan, several outbreak accidents caused by MRAB have been reported so far. In this case, genetic analysis revealed that the pathogen had originated from a foreign country, and the prevalence of colistin-resistant pathogens has also increased in these countries. Besides adequate isolation precautions, strategies for post-neurosurgical SSI management and establishment of effective treatments are necessary against neurosurgical SSIs caused by colistin-resistant MRAB.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Brain Abscess; China; Colistin; Drug Resistance, Multiple, Bacterial; Humans; Male; Middle Aged; Surgical Wound Infection; Travel

Topics: Adult; Brain Abscess; Cerebellar Diseases; Colistin; Humans; Male; Otitis; Penicillins

Topics: Abscess; Amphotericin B; Brain Abscess; Candidiasis; Carrier State; Child; Chloramphenicol; Colistin; Deoxyribonucleases; DNA; Empyema; Enteritis; Humans; Kanamycin; Meningitis; Methicillin; Penicillins; Peritonitis; Phlebitis; Pneumonia; Pneumothorax; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Sulfadiazine; Troleandomycin