Intrathecal colistin for drug-resistant Acinetobacter baumannii central nervous system infection: a case series and systematic review.

Abstract

Treatment limitations exist for drug-resistant Acinetobacter baumannii central nervous system (CNS) infection. We conducted a retrospective study and systematic literature review to identify patients with drug-resistant A. baumannii CNS infection who received primary or adjunct intrathecal or intraventricular (IT/IVT) colistin. In a case series of seven Thai patients and 17 patients identified in the literature, clinical and microbiological cure rates with IT/IVT colistin therapy were 83% and 92%, respectively. Three patients (13%) developed chemical ventriculitis and one (4%) experienced treatment-associated seizures. Death was associated with delayed IT/IVT colistin therapy compared to survival (mean time from diagnosis to IT/IVT colistin, 7 vs. 2 days; p 0.01). The only independent predictor of mortality was the severity of illness (APACHE II score > 19, adjusted odds ratio 49.5; 95% CI 1.7-1428.6; p 0.02). This case series suggests that administration of primary or adjunctive IT/IVT colistin therapy was effective for drug-resistant A. baumannii CNS infection.

• Authors: T Khawcharoenporn, A Apisarnthanarak, L M Mundy
• Journal: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases (Clin Microbiol Infect) Vol. 16 Issue 7 Pg. 888-94 (Jul 2010) ISSN: 1469-0691 [Electronic] England
• PMID: 19686281 (Publication Type: Case Reports, Journal Article, Review, Systematic Review)

Chemical References

• Anti-Bacterial Agents
• Colistin

Topics

• APACHE
• Acinetobacter Infections (drug therapy, microbiology)
• Acinetobacter baumannii (drug effects)
• Adolescent
• Adult
• Aged
• Anti-Bacterial Agents (administration & dosage, pharmacology, therapeutic use)
• Central Nervous System Bacterial Infections (drug therapy, microbiology)
• Central Nervous System Infections (drug therapy)
• Child
• Child, Preschool
• Colistin (administration & dosage, adverse effects, pharmacology, therapeutic use)
• Cross Infection (drug therapy, epidemiology, microbiology)
• Drug Resistance, Multiple, Bacterial
• Female
• Humans
• Injections, Intraventricular
• Injections, Spinal
• Male
• Middle Aged
• Risk Factors
• Thailand
• Treatment Outcome