colistin and Craniocerebral-Trauma

Post-neurosurgical nosocomial meningitis has become an important subgroup of bacterial meningitis in the hospital setting. The increase in meningitis caused by multidrug-resistant (MDR) Acinetobacter baumannii has resulted in a significant reduction in available treatment options.. We report the case of a 36-year-old man with a complex craniofacial trauma, who developed a nosocomial meningitis due to MDR A. baumannii that was cured by intrathecal colistin. The case is contextualized among all the published cases of Acinetobacter meningitis treated with topical colistin found through a MEDLINE search of the literature. To date, including the present case, eight reported cases of Acinetobacter meningitis have been treated with colistin administered by an intrathecal route and 24 by an intraventricular route. The daily dose of colistin used ranged from 1.6 mg every 24 h to 20 mg every 24 h in adult patients. The median time necessary to obtain cerebrospinal fluid sterilization was 4.1 days, and treatment was always successful even if in two cases Acinetobacter meningitis relapsed. Toxicity probably or possibly related to the topical administration of colistin was noted in five out of the 32 patients.. Topical colistin can be an effective and safe treatment for MDR Acinetobacter meningitis.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Anti-Bacterial Agents; Colistin; Craniocerebral Trauma; Drug Resistance, Multiple, Bacterial; Humans; Injections, Spinal; Male; Meningitis, Bacterial; Postoperative Complications; Treatment Outcome

Intrathecal colistin (Polymxin E) is becoming an important option for the treatment of post-neurosurgical meningitis caused by multidrug resistant (MDR) Acinetobacter baumannii. We report a case of 28-year-old man who developed meningitis due to MDR A. baumannii associated with an external ventricular drain. The patient was cured using a 4-week course of intrathecal colistin 3.2 mg via external ventricular drain (EVD) daily without any serious side effects.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Anti-Bacterial Agents; Colistin; Craniocerebral Trauma; Drug Resistance, Multiple, Bacterial; Humans; Injections, Spinal; Male; Meningitis, Bacterial; Postoperative Complications

Nosocomial infections and their rational antibiotic treatment represent a major challenge for the healthcare nowadays. In this context, gramnegative bacteria including Pseudomonas aeruginosa, Acinetobacter baumanii and Enterobacteriaceae spp. are etiologically important and characterized by a significant level of antibiotic resistance. To examine dynamics of the respiratory tract colonization by hospital flora, tracheal aspirates obtained at three time points from 69 children with severe craniocerebral trauma during their stay in ICU were analysed. Colonization was observed on the 4th day of the ICU stay with predomination of K. pneumoniae (45%) and A. baumanii (27-37%). P. aeruginosa was detected after the 8th day of the ICU stay with the isolation rate of 33%. Substantial proportions of P. aeruginosa (61%), A. baumanii (78%) and K. pneumoniae (25%) were resistant to carbapenems. In 65 carbapemen resistant isolates, the presence of carbapenemases was examined using PCRs. OXA-48 carbapenemase was detected in 11 out of 14 (78%) K. pneumoniae isolates. Among the A. baumanii isolates, 30/31 (97%) carried OXA-40 and 1/31 (3%) had OXA-23 carbapenemases. None of the examined A. baumanii and K. pneumoniae isolates produced metallo-betalactamases (MBL). In contrast, all 20 carbapenem resistant P. aeruginosa isolates produced a MBL, and in 12 out of 20 (60%) of theme VIM-2 was detected. Thus, gramnegative nosocomial microflora rapidly colonizes ICU patients and has a high level of resistance to antibiotics, including carbapenems.

Topics: Acinetobacter baumannii; Aminoglycosides; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; beta-Lactams; Child; Colistin; Craniocerebral Trauma; Cross Infection; Drug Monitoring; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae Infections; Gene Expression; Humans; Intensive Care Units, Pediatric; Klebsiella pneumoniae; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Respiratory Tract Infections; Trachea; Trauma Severity Indices

Post-surgical meningitis and/or ventriculitis caused by Gram-negative bacteria may be difficult to treat due to the emergence of multiresistant strains. Two patients with multiresistant Acinetobacter baumannii central nervous system infection, successfully treated with either intravenous and/or intraventricular colistin are presented. Unresolved issues such as dose and duration of intraventricular colistin are discussed.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Aneurysm, Ruptured; Anti-Bacterial Agents; Colistin; Craniocerebral Trauma; Cross Infection; Device Removal; Drug Resistance, Multiple, Bacterial; Female; Humans; Hydrocephalus; Injections, Intraventricular; Intracranial Aneurysm; Male; Postoperative Complications; Ventriculoperitoneal Shunt

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Anti-Bacterial Agents; Colistin; Craniocerebral Trauma; Cross Infection; Drug Resistance, Bacterial; Humans; Injections, Spinal; Male; Meningitis, Bacterial

A 28-year-old man developed five episodes of meningitis, all due to multiresistant Gram-negative rods during his 7-month hospitalisation after head trauma. This patient's recurrent meningitis was solved only when colistin and amikacin were given by the intraventricular in addition to the intravenous route for a long period of time, specifically 6 weeks.

Topics: Adult; Colistin; Craniocerebral Trauma; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacterial Infections; Humans; Injections, Intraventricular; Male; Meningitis, Bacterial; Neurosurgical Procedures; Recurrence