colistin and Subarachnoid-Hemorrhage

We present the case of a patient with ventilator-associated pneumonia (VAP) caused by a pan-resistant Acinetobacter baumannii successfully treated with the combination colistin plus vancomycin plus rifampin, whose in vitro activity was investigated by checkerboard method and killing testing. Furthermore, the serum bactericidal activity (SBA) was assessed. Our case shows that an innovative regimen consisting of colistin plus antimicrobials active only against Gram-positive microorganisms might represent a valid therapeutic option for severe infections caused by colistin-resistant A. baumannii.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Aged; Anti-Bacterial Agents; Antibiotics, Antitubercular; Colistin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Humans; Male; Microbial Sensitivity Tests; Neurosurgical Procedures; Pneumonia, Ventilator-Associated; Rifampin; Subarachnoid Hemorrhage; Vancomycin

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Topics: Anti-Bacterial Agents; Colistin; Female; Gram-Negative Bacterial Infections; Humans; Injections, Intraventricular; Meningoencephalitis; Middle Aged; Stenotrophomonas maltophilia; Subarachnoid Hemorrhage

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