Acinetobacter baumannii is an important pathogen which causes severe
nosocomial infections such as
meningitis. Multidrug resistance is a growing problem throughout the world. In this report a case of multidrug resistant A.baumannii
meningitis, treated with high dose of
ampicillin-sulbactam (SAM) was presented.
Rhinorrhea and
confusion developed on the postoperative seventh day in a 67 years old male patient operated for macroadenoma of the hyphophysis gland. Since the cerebrospinal fluid (CSF) findings indicated a
central nervous system infection, nosocomial
meningitis was diagnosed and intravenous
ceftazidime and
vancomycin have started. Blood and CSF cultures of the patient revealed no growth and his general condition has improved. However,
fever and
confusion emerged again on the 21st day of
therapy and the repeat CSF sample revealed increased pressure, purulent appearance, 510/mm3 leukocytes (90% PMNL), 58 mg/dl
glucose (simultaneous
blood glucose was 144 mg/dl) and 49 mg/dl
protein. Direct microscopic examination of CSF revealed gram-negative coccobacilli and A.baumannii was identified in the culture. The isolate was resistant to
piperacillin-tazobactam,
third generation cephalosporins,
aztreonam,
ciprofloxacin,
carbapenems and
aminoglycosides, susceptible to
sulbactam ampicillin and
colistin.
Ampicillin (12 gr) and
sulbactam (6 gr) treatment was initiated and at the 72nd hour of the
therapy the temperature and conciousness level of the patient returned to normal. Control CSF sample obtained on the 14th day of treatment revealed no leukocytes and no bacterial growth. The treatment was continued for 21 days and the patient recovered without any sequela. Since
colistin which is one of the alternative antimicrobial treatment choices for resistant
Acinetobacter infections, is not found in Turkey,
sulbactam-
ampicillin might be an effective and safe choice for the treatment of multi-resistant A. baumannii
meningitis if the isolate was proven to be susceptible by
antibiotic susceptibility tests.