colistin and Meningitis

We present a case of Gram-negative neurosurgical meningitis in a neonate, refractory to optimal intravenous therapy and removal of ventriculoperitoneal shunt. Cerebrospinal fluid was sterilized within 24 hours using intraventricular colistin. This is the first report of intraventricular colistin use in neonatal meningitis caused by Enterobacter cloacae.

Topics: Anti-Bacterial Agents; Colistin; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Male; Meningitis; Neurosurgical Procedures; Postoperative Complications; Treatment Outcome; Ventriculoperitoneal Shunt

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

Topics: Age Factors; Ampicillin; Anti-Bacterial Agents; Carbenicillin; Cephalothin; Child; Child, Preschool; Cloxacillin; Colistin; Female; Gentamicins; Humans; Infant; Infant, Newborn; Kanamycin; Male; Meningitis; Methods

Topics: Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Biliary Tract Diseases; Carbenicillin; Cephalosporins; Chloramphenicol; Colistin; Endocarditis, Subacute Bacterial; Gentamicins; Humans; Meningitis; Osteomyelitis; Oxacillin; Sepsis; Tetracycline; Urinary Tract Infections

Limited therapeutic options exist for multidrug-resistant/extensively drug-resistant Acinetobacter baumannii (MDR/XDR-Ab) meningitis/ventriculitis. A combination of intravenous and intraventricular (IVT)/intrathecal (IT) polymyxins achieves good therapeutic outcomes for cases of healthcare-associated MDR/XDR-Ab meningitis/ventriculitis. Colistin is commercially available as colistin sulphate and its sulphomethylated derivative. However, the effect and safety of colistin sulphate in the treatment of MDR/XDR-Ab meningitis/ventriculitis has not been reported. We report on a 66-year-old male patient who developed post-neurosurgical ventriculitis caused by MDR-Ab. IVT concomitant intravenous colistin sulphate was used as a last-resort antimicrobial therapy, the patient's ventriculitis was dramatically improved, and the concentrations of CSF colistin were higher than the MIC breakpoint throughout the treatment. Meanwhile, no nephrotoxicity or neurotoxicity was observed during the treatment.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Aged; Anti-Bacterial Agents; Cerebral Ventriculitis; Colistin; Drug Resistance, Multiple, Bacterial; Humans; Male; Meningitis

Topics: Anti-Bacterial Agents; Child; Colistin; Drug Resistance, Multiple, Bacterial; Humans; Infant, Newborn; Meningitis; Meningitis, Bacterial

Meningitis due to resistant microorganisms after neurosurgical intervention progresses with significant morbidity and mortality. Treatment is difficult as the antibiotics available for this purpose as well as their transition to the cerebrospinal fluid are limited. Due to the inability of the intravenously administered colistin to cross the blood-brain barrier sufficiently, intraventricular colistin application is recommended in the treatment of meningitis. Herein we report successful treatment with intraventricular colistin of an infant with ventriculoperitoneal shunt-related meningitis due to extended spectrum β-lactamase-producing Klebsiella pneumoniae. The infant lacked clinical response despite effective intravenous antibiotic therapy. Intrathecal/intraventricular colistin can be an effective alternative in the treatment of resistant Gram-negative bacilli meningitis.

Topics: Anti-Bacterial Agents; Colistin; Humans; Infant; Klebsiella pneumoniae; Meningitis; Ventriculoperitoneal Shunt

Topics: Acinetobacter; Anti-Bacterial Agents; Cerebral Ventriculitis; Colistin; Humans; Infant, Newborn; Meningitis; Sepsis

In this study we retrospectively reviewed A. baumannii meningitis cases treated with tigecycline including regimens and evaluated the efficacy of tigecycline in the therapy.. Study was performed in seven tertiary-care educational hospitals from five cities of Turkey and one center from France. We extracted data and outcomes of all adult (aged >18) patients with culture proven A. baumannii meningitis treated with tigecycline including antibiotic therapy until April 2016.. A total of 23 patients (15 male and eight female) fulfilled our inclusion criteria. All Acinetobacter strains were carbapenem-resistant and susceptible to tigecycline. Six cases received tigecycline monotherapy while 17 received tigecycline including combination therapy (10 with colistin, 4 with netilmicin, 3 with amikacin, 4 with meropenem). Seven of 23 cases (30%) died during the tigecycline including therapy (1 in monotherapy, 4 in colistin, 2 in netilmicin, 1 amikacin, one case received tigecycline + netilmicin followed by tigecycline + colistin). Hence, overall end of treatment (EOT) success was 70%. However, since further 27% died due to additional nosocomial infections, overall clinical success (relieved symptoms at the EOT and one-month post-therapy survival without any relapse or reinfection) decreased to 43%.. We conclude that tigecycline may be an alternative in the salvage treatment of nosocomial multidrug-resistant Acinetobacter spp. meningitis. Acinetobacter spp. Meningitis.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Aged; Anti-Bacterial Agents; Colistin; Female; Humans; Male; Meningitis; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Tigecycline

Topics: Aged; Anti-Bacterial Agents; Azabicyclo Compounds; beta-Lactamase Inhibitors; Ceftazidime; Colistin; Drug Combinations; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Humans; Lung Abscess; Male; Meningitis; Middle Aged; Pseudomonas aeruginosa; Pseudomonas Infections; Radiography, Thoracic; Tomography, X-Ray Computed; Treatment Outcome

Tigecycline is a broad-spectrum antibiotic with activity against multidrug-resistant (MDR) bacteria. It has limited indications. Studies are necessary to elaborate new guidelines. Here we report a case of postoperative MDR Acinetobacter baumannii meningitis treated by tigecycline combined with colimycin for 21 days. The treatment was well tolerated with a favourable outcome. In conclusion, tigecycline was shown to be effective in a case of MDR A. baumannii meningitis.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Anti-Bacterial Agents; Colistin; Drug Resistance, Multiple, Bacterial; Humans; Male; Meningitis; Microbial Sensitivity Tests; Minocycline; Tigecycline

Sepsis due to multidrug-resistant Gram-negative pathogens is a challenge for clinicians and microbiologists and has led to use of parenteral colistin. There is a paucity of data regarding safety and efficacy of intravenous colistin use in neonates. The objective of this retrospective analysis was to study the efficacy and safety of intravenous colistin in the treatment of neonatal sepsis.. An audit of the data from neonates, admitted to a neonatal intensive care unit of a tertiary care hospital during January 2012 to December 2012, and who received intravenous colistin was carried out.. Sixty two neonates received intravenous colistin (52 preterm and 10 term) for the treatment of pneumonia, bloodstream infections and meningitis. The isolated pathogens in decreasing order of frequency were Acinetobacter baumannii, Klebsiella pneumonia and Pseudomonas aeruginosa. Of the total 62 neonates, 41 (66.12%) survived and 21 (33.87%) died. Significantly higher mortality was observed in neonates with lower body weights (P < 0.05). A significant association of mortality was found in those with sepsis due to Klebsiella species. Only one of seven with this infection survived as against 15 of the 23 who grew other organisms [P = 0.03; crude odds ratio = 11.25 (1.2, 110.5)]. None of the neonates developed neurotoxicity or nephrotoxicity.. This retrospective study in neonates with sepsis showed that intravenous colistin was safe and effective in the treatment of neonatal sepsis. Further, well-controlled, prospective clinical trials need to be done to corroborate these findings.

Topics: Acinetobacter baumannii; Administration, Intravenous; Colistin; Female; Humans; Infant, Newborn; Klebsiella pneumoniae; Male; Meningitis; Neonatal Sepsis; Pneumonia; Pseudomonas aeruginosa; Tertiary Care Centers

Treatment results of six post-neurosurgical ventriculitis and meningitis cases caused by extensively drug-resistant Acinetobacter baumannii after application of an intraventricular loading dose of 500000 IU (40 mg) of colistin followed by a dose of 125000-250000 IU (10-20 mg) every 24-48 h plus parenteral colistin are reported. Simultaneous bacteraemia with an identical Acinetobacter strain was observed in three patients. The mean duration of treatment was 17.2 days (range 15-21 days) and the median time of sterilisation of cerebrospinal fluid was 2.5 days (range 1-5 days). All patients were cured, however one patient presented with chemical meningitis and one with chemical ventriculitis, conditions that clinically and biochemically resemble bacterial meningitis.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Anti-Bacterial Agents; Cerebral Ventriculitis; Cerebrospinal Fluid; Colistin; Drug Resistance, Multiple, Bacterial; Female; Humans; Infusions, Intraventricular; Male; Meningitis; Middle Aged; Surgical Wound Infection; Time Factors; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Colistin; Drug Resistance, Multiple, Bacterial; Female; Humans; Infusions, Intralesional; Infusions, Intravenous; Injections, Spinal; Meningitis; Pseudomonas aeruginosa; Pseudomonas Infections; Treatment Outcome

Topics: Colistin; Drug Therapy, Combination; Humans; Male; Meningitis; Middle Aged; Piperacillin; Pseudomonas Infections

The chemotherapy of septicaemia in newborns differs fundamentally from that in older children or adults because, although newborns have a fully developed immunological system, the system has not yet "learned" to operate completely. Ultimately, optimal chemotherapy can only be found empirically. In this respect a few basic guidelines can be given however: 1. The initial therapy must bring the pathogen under control with a high degree of certainty, since a correction in therapy following pathogen indentification is usually too late. 2. Since the pharmacokinetics of antibiotics in newborns vary considerably, the minimal peak serum concentration observed should exceed the MIC of the pathogen. 3. In rapidly maturing newborns and premature babies the pharmacokinetics of each antibiotic must be known precisely. 4. Since in the individual case there can never be absolute certainty with respect to the three above-mentioned problems, combination therapy should be given at all times.

Topics: Amikacin; Anti-Bacterial Agents; Cefuroxime; Colistin; Dose-Response Relationship, Drug; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Meningitis; Sepsis; Tobramycin

Topics: Colistin; Humans; Injections, Spinal; Meningitis; Polymyxins; Pseudomonas Infections; Urinary Tract Infections

35 patients were secondarily infected in our hospital with a strain of A. calcoaceticus resistant to the usual antibiotics and sulfonamides, but sensitive to colimycin. The epidemic lasted 118 days and is not yet finished. Each of the infected patients had a severe surgical or medical illness, underwent operations, trachetomy, etc. and was treated with antibiotics. A. calcoaceticus persisted alone or was associated with other bacteria from 1 to 46 days, in specimens (sputum, etc. or in blood) sometimes until death. It is not pathogenic for rabbits and mice; its pathogenicity in man is discussed in the text. The epidemic strain was not harboured by 15 doctors, students or nurses, nor present on 147 objects in the vicinity of the patients, but was found in a bottle of aqueous 1% eosin solution in the room of an infected child. Experiments show that A. calcoaceticus is not killed by a 1% eosin solution, and freely multiplies in broth containing 0,5% eosin. It is easy to identify the first case and chronology of the epidemic, but it is less easy to identify each time the means of propagation. Usually, infected patients seem to be the source of further infection. Does eosin paly more than an occasional role? Were the germs transported by dust? This not very disturbing epidemic suggests that less pathogenic germs may still cause unsuspected hospital epidemics.

Topics: Acinetobacter; Adolescent; Adult; Aged; Alcaligenes; Anti-Bacterial Agents; Bacterial Infections; Bronchopneumonia; Child; Child, Preschool; Colistin; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Female; Humans; Infant; Male; Meningitis; Microbial Sensitivity Tests; Middle Aged; Pseudomonas aeruginosa

Three cases of salmonella meningitis in infants were successfully treated with a combination of intraventricular and systemic antibiotics after standard treatment had failed. The intraventricular antibiotics were administered through a subcutaneously implanted ventriculostomy reservoir. The ventricular fluid cultures were positive in all cases. The organisms in the ventricle may periodically reinoculate the subarachnoid space and add to the difficulty in curing salmonella meningitis. Details of the prolonged treatment (29-59 days) and the antibiotic levels obtained are presented. No local reservoir complications were encountered. All three patients were developing normally 10 to 18 months following treatment including two who required a shunt procedure for nonabsorptive hydrocephalus.

Topics: Ampicillin; Anti-Bacterial Agents; Chloramphenicol; Colistin; Drug Therapy, Combination; Gentamicins; Humans; Infant; Infant, Newborn; Male; Meningitis; Penicillins; Salmonella Infections

Topics: Acute Disease; Child; Child, Preschool; Chloramphenicol; Colistin; Female; Follow-Up Studies; gamma-Globulins; Glucocorticoids; Humans; Infant; Infant, Newborn; Male; Meningitis; Penicillin G; Sulfonamides; Suppuration

Topics: Ampicillin; Antigens, Bacterial; Cephalothin; Child; Chloramphenicol; Colistin; Escherichia coli; Gentamicins; Humans; Immune Sera; Infant; Kanamycin; Meningitis; Neomycin; Penicillin Resistance; Polymyxins; Sepsis; Serotyping; Streptomycin; Tetracycline; Urinary Tract Infections

Topics: Carbenicillin; Colistin; Ecthyma; Gentamicins; Humans; Leukemia; Leukemia, Lymphoid; Lymphoma; Meningitis; Neutropenia; Pneumonia; Polymyxins; Pseudomonas aeruginosa; Pseudomonas Infections; Sepsis; Uremia

Topics: Ampicillin; Animals; Carbenicillin; Colistin; Female; Gentamicins; Germany, West; Gestational Age; Hemiplegia; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Male; Meningitis; Oxacillin; Pregnancy; Prognosis; Spinal Puncture

During a serious epidemic of chest and urinary infections due to Klebsiella aerogenes in a neurosurgical unit, several patients developed klebsiella meningitis after trauma or surgery. Despite all attempts to control the epidemic and treat the meningitis with antibiotics, eight of the nine patients died. It was not until all antibiotics used to treat respiratory and urinary infections had been totally withdrawn that no further patients developed klebsiella meningitis.

Topics: Adult; Ampicillin; Child; Child, Preschool; Cloxacillin; Colistin; Cross Infection; Disease Outbreaks; Female; Gentamicins; Humans; Injections, Spinal; Klebsiella Infections; Male; Meningitis; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Scotland; Surgical Wound Infection

Topics: Anti-Bacterial Agents; Colistin; Female; Gentamicins; Humans; Infant; Infant, Newborn; Injections, Spinal; Meningitis; Paraplegia; Spinal Cord Diseases

Topics: Adult; Anti-Bacterial Agents; Carbenicillin; Colistin; Drug Synergism; Female; Gentamicins; Humans; In Vitro Techniques; Injections; Male; Meningitis; Middle Aged; Polymyxins; Pseudomonas; Pseudomonas Infections; Species Specificity

Topics: Adult; Anesthesia, Spinal; Bacteriocins; Bacteriophage Typing; Colistin; Female; Humans; Meningitis; Polymyxins; Pregnancy; Pseudomonas Infections; Spinal Puncture

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cephaloridine; Chloramphenicol; Colistin; Erythromycin; Escherichia coli; Female; Gentamicins; Humans; Kanamycin; Lincomycin; Male; Meningitis; Microbial Sensitivity Tests; Middle Aged; Novobiocin; Penicillins; Radiography; Respiratory Tract Infections; Sepsis; Staphylococcus; Streptococcus; Streptomycin; Sulfonamides; Tetracycline; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Colistin; Cross Infection; Disease Outbreaks; Humans; Intensive Care Units; Klebsiella; Klebsiella Infections; Meningitis; Neurosurgery; Respiratory Tract Infections; Sputum; Urinary Tract Infections

Topics: Child; Child, Preschool; Colistin; Gentamicins; Humans; Infant; Kanamycin; Meningitis; Penicillin G; Sulfonamides; Suppuration

Topics: Child; Colistin; Drug Synergism; Humans; Leukemia, Lymphoid; Male; Meningitis; Penicillin Resistance; Penicillins; Pseudomonas aeruginosa

Topics: Adult; Anti-Bacterial Agents; Colistin; Female; Humans; Meningitis; Polymyxins; Pseudomonas aeruginosa; Pseudomonas Infections; Time Factors

Topics: Ampicillin; Anti-Bacterial Agents; Cephalosporins; Child; Cloxacillin; Colistin; Drug Synergism; Dysentery, Bacillary; Endocarditis, Bacterial; Humans; Infections; Lincomycin; Meningitis; Nafcillin; Neomycin; Oxacillin; Penicillin Resistance; Penicillins; Pneumococcal Infections; Polymyxins; Shigella; Streptococcal Infections; Sulfamethoxazole; Tetracycline; Urinary Tract Infections

Topics: Amphotericin B; Bronchopneumonia; Candidiasis; Child; Colistin; Female; Humans; Iatrogenic Disease; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Male; Meningitis; Sepsis; Sterilization; Vaccination

Topics: Animals; Brain; Chloramphenicol; Colistin; Electrocardiography; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Fever; Humans; Infant, Newborn; Infant, Newborn, Diseases; Leukocyte Count; Meningitis; Penicillins; Sepsis; Snakes; Spinal Puncture; Streptomycin; Sulfadiazine

Topics: Ampicillin; Colistin; Communicable Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Oxacillin; Pneumonia; Pseudomonas Infections; Pyoderma; Sepsis

Topics: Anti-Bacterial Agents; Child; Chloramphenicol; Colistin; Diazepam; Heparin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Penicillins; Pneumonia, Staphylococcal; Prednisone; Sepsis; Sulfonamides

Topics: Acinetobacter; Blood; Child, Preschool; Colistin; Drug Resistance, Microbial; Female; Humans; Kanamycin; Meningitis; Neomycin; Nitrofurantoin; Nose; Polymyxins; Skin; Sputum; Streptomycin; Tetracycline; Urine

Topics: Colistin; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Meningitis; Pseudomonas aeruginosa; Pseudomonas Infections

Topics: Chloramphenicol; Colistin; Humans; Hydrocephalus; Infant; Infant, Newborn; Meningitis; Meningocele

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

Topics: Anti-Bacterial Agents; Bacteriological Techniques; Cerebrospinal Fluid; Chloramphenicol; Colistin; Coma; Diagnosis; Epidemiology; Erythromycin; Listeria; Listeria monocytogenes; Meningitis; Meningitis, Listeria; Novobiocin; Oleandomycin; Oxytetracycline; Penicillins; Seizures; Sepsis; Serologic Tests; Spiramycin; Sulfonamides; Tetracycline

Topics: Adolescent; Anti-Bacterial Agents; Child; Chloramphenicol; Colistin; Drug Therapy; Geriatrics; Infant; Infant, Newborn; Meningitis; Meningococcal Infections; Penicillins; Polymyxins; Streptomycin; Sulfonamides; Tetracycline

Topics: Colistin; Drug Therapy; Escherichia coli Infections; Humans; Meningitis; Pseudomonas aeruginosa; Pseudomonas Infections; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Colistin; Humans; Hydrocortisone; Infant, Newborn; Infant, Newborn, Diseases; Listeria; Meningitis; Meningitis, Listeria; Methicillin; Oxytetracycline; Penicillins; Streptomycin; Sulfisoxazole

Topics: Colistin; Cross Infection; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Kanamycin; Klebsiella; Klebsiella Infections; Klebsiella pneumoniae; Meningitis; Ophthalmology; Oxytetracycline; Polymyxins

Topics: Anti-Bacterial Agents; Bacillus; Child; Colistin; Escherichia coli; Escherichia coli Infections; Infant; Meningitis