colistin and Encephalitis

Nosocomial infections with organisms resistant to multiple antibiotic agents represent an evolving challenge in the intensive care setting, particularly in patients requiring surgical diversion of cerebrospinal fluid. The authors present the case of a 51-year-old woman who endured protracted hospitalization and required multiple surgeries including placement of a ventriculoperitoneal shunt. The shunt subsequently became colonized with Pseudomonas aeruginosa, which demonstrated intermediate sensitivity to amikacin and full resistance to all other antibiotics tested 'After failing to respond to intravenous imipenem as well as intravenous and intrathecal amikacin, the patient was successfully treated with intravenous and intrathecal colistin. Colistin is a polymyxin-type antibiotic, rarely used outside of topical application because of reported nephrotoxicity associated with parenteral administration. With activity limited to Gram-negative organisms, colistin is bactericidal by directly disrupting the structure of cell membranes. Authors of a few case reports in the literature have described successful treatment of various ventriculitis with the intrathecal administration of colistin. With bacterial resistances outpacing the pharmaceutical industry's ability to develop novel antibiotics, colistin represents an important alternative in situations involving multidrug-resistant organisms.

Topics: Anti-Bacterial Agents; Cerebral Ventricles; Cerebrospinal Fluid Shunts; Colistin; Cross Infection; Drug Resistance, Multiple; Encephalitis; Female; Humans; Injections, Spinal; Middle Aged; Postoperative Complications; Pseudomonas Infections

Bacterial diseases of the central nervous system develop per continuitatem of haematogenically. Each of these two groups can further be subdivided. As an initial therapy when an unknown agent is present chloramphenicol in high doses (200 mg/kg KM) stood the test for adults and older children and ampicillin (200 to 400 mg/kg KM), respectively, for babies and infants. In case of need, this therapy is correlated according to the findings of the culture and the antibiogramme. In secondary meningitides the surgical cure of the focus should be performed only after improvement of the general condition. Recidivating meningitides undergo an operation when liquor fistulae are proved. In an unclarified cause a long-term therapy with oxacillin or lincomycin over 3-6 months is possible. In the meningitis of newborn the combination of ampicillin, carbenicillin or colistin with gentamycin is necessary, intravenously and intrathecally. Hydrocortisone and streptokinase shall prevent the transfer of the liquor spaces. Of great importance is the combat against the cerebral oedema. In mycetogenous meningitis amphotericin B, eventually in combination with 5-fluorocytosine, can be used. There are still no effective remedies against the amoebic meningo-encephalitis.

Topics: Ampicillin; Bacterial Infections; Carbenicillin; Chloramphenicol; Colistin; Drug Therapy; Encephalitis; Humans; Injections, Intravenous; Injections, Spinal; Lincomycin; Meningitis; Oxacillin

"Healthcare-associated ventriculitis and meningitis" is a potentially devastating illness following neurosurgical procedures. Multidrug resistant (MDR) and extensively drug resistant (XDR) organisms such as Acinetobacter baumannii and Klebsiella pneumoniae have increasingly been isolated in ventriculitis and meningitis episodes. The treatment of these infections can be challenging, as the antimicrobial options are restricted. Regarding Central Nervous System (CNS) infections the transfer of the antibiotics to the Cerebrospinal Fluid (CSF) is often low which results in decreased drug levels at the infection site. The intraventricular (IVT) administration of antibiotics can be used as an adjunct to the intravenous (IV) treatment of Gram-negative MDR ventriculitis and meningitis, yet pertinent data is scarce. We present the successful management of three cases of healthcare-associated ventriculitis and meningitis due to XDR species with the combined intraventricular administration of colistin and off-label tigecycline, after the initial regimen of colistin given alone through both IVT and IV routes had failed.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Administration, Intravenous; Anti-Bacterial Agents; Central Nervous System; Cerebral Ventriculitis; Colistin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Encephalitis; Female; Humans; Infusions, Intraventricular; Injections, Intraventricular; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Research Design; Tigecycline; Young Adult

Topics: Acinetobacter baumannii; Acinetobacter Infections; Colistin; Encephalitis; Female; Humans; Lateral Ventricles; Male

Acinetobacter baumannii has emerged as an important nosocomial pathogen that can cause a multitude of severe infections. In neurosurgical patients the usual presentation is ventriculitis associated with external ventricular drainage. Carbapenems have been considered the gold standard for the treatment of Acinetobacter baumannii ventriculitis, but resistant isolates are increasing worldwide, reducing the therapeutic options. In many cases polymyxins are the only possible alternative, but their poor blood-brain barrier penetration could require them to be directly administered intraventricularly and clinical experience with this route is limited. We review the literature concerning intraventricular use of colistin (polymyxin E) for A. baumannii ventriculitis and add three cases successfully treated with this method. Our experience suggests that intraventricular colistin is a potentially effective and safe therapy for the treatment of multidrug-resistant A. baumannii central nervous system infections.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Anti-Bacterial Agents; Brain; Cerebrospinal Fluid Shunts; Colistin; Cross Infection; Drug Resistance, Multiple; Encephalitis; Fatal Outcome; Female; Humans; Hydrocephalus; Injections, Intraventricular; Lateral Ventricles; Male; Meningitis, Bacterial; Middle Aged; Subarachnoid Hemorrhage; Tomography, X-Ray Computed; Treatment Outcome; Ventriculostomy

Management of multidrug-resistant Acinetobacter baumannii (MDRAB) meningitis/ventriculitis is a difficult therapeutic problem owing to the limited penetration of antibiotics into cerebrospinal fluid (CSF). A 2-month-old girl with ventriculitis caused by MDRAB is reported. Despite therapy with intravenous (IV) colistin ventricular fluid, cultures remained positive for MDRAB. Institution of combination therapy with IV and intraventricular colistin resulted in a successful clinical and microbiological outcome. Intraventricular/intrathecal and IV colistin might be the best therapeutic option in the treatment of central nervous system infection caused by MDRAB. Further studies are required to evaluate pharmacokinetic and pharmacodynamic parameters of combined IV and intraventricular/intrathecal colistin administration, especially in children.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; Cerebral Ventricles; Colistin; Drug Resistance, Multiple, Bacterial; Encephalitis; Female; Humans; Infant; Injections, Intraventricular; Meningitis, Bacterial; Treatment Outcome

Topics: Acinetobacter; Acinetobacter Infections; Adolescent; Adult; Anti-Bacterial Agents; Brain Diseases; Carbapenems; Central Nervous System Bacterial Infections; Cerebral Ventricles; Colistin; Drug Resistance, Microbial; Encephalitis; Female; Humans; Injections, Intraventricular; Male; Middle Aged; Treatment Outcome

Topics: Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Chloramphenicol; Colistin; Cortisone; Encephalitis; Erythromycin; Kanamycin; Liver Diseases; Mice; Penicillins; Pharmacology; Protein Synthesis Inhibitors; Research; Rodent Diseases; Streptomycin; Sulfonamides; Tetracycline