title: 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.affiliation: Division of Infectious Diseases and Infection Control, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand.
authors.forename: T
authors.initials: T
authors.lastname: Khawcharoenporn
authors.forename: A
authors.initials: A
authors.lastname: Apisarnthanarak
authors.forename: L M
authors.initials: LM
authors.lastname: Mundy
mesh_terms: D018806:APACHE; D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D020806:Central Nervous System Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D002494:Central Nervous System Infections / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003091:Colistin / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007276:Injections, Intraventricular; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013785:Thailand; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin