Multidrug-resistant Acinetobacter baumannii ventriculitis: successful treatment with intraventricular colistin.
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.
López-Alvarez
B
B
Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain. b_lopez_alv@yahoo.es
Martín-Láez
R
R
Fariñas
M C
MC
Paternina-Vidal
B
B
García-Palomo
J D
JD
Vázquez-Barquero
A
A
D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000502:physiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001921:Brain / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D002557:Cerebrospinal Fluid Shunts; D003091:Colistin / Q000008:administration & dosage*; D003428:Cross Infection / Q000188:drug therapy / Q000517:prevention & control; D018432:Drug Resistance, Multiple; D004660:Encephalitis / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D007276:Injections, Intraventricular / Q000379:methods; D020547:Lateral Ventricles / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods
D000900:Anti-Bacterial Agents; D003091:Colistin