title: Post-neurosurgical multidrug-resistant Acinetobacter baumannii meningitis successfully treated with intrathecal colistin. A new case and a systematic review of the literature.
abstract: BACKGROUND
  Post-neurosurgical nosocomial meningitis has become an important subgroup of bacterial meningitis in the hospital setting. The increase in meningitis caused by multidrug-resistant (MDR) Acinetobacter baumannii has resulted in a significant reduction in available treatment options.
  
  
  BACKGROUND
  We report the case of a 36-year-old man with a complex craniofacial trauma, who developed a nosocomial meningitis due to MDR A. baumannii that was cured by intrathecal colistin. The case is contextualized among all the published cases of Acinetobacter meningitis treated with topical colistin found through a MEDLINE search of the literature. To date, including the present case, eight reported cases of Acinetobacter meningitis have been treated with colistin administered by an intrathecal route and 24 by an intraventricular route. The daily dose of colistin used ranged from 1.6 mg every 24 h to 20 mg every 24 h in adult patients. The median time necessary to obtain cerebrospinal fluid sterilization was 4.1 days, and treatment was always successful even if in two cases Acinetobacter meningitis relapsed. Toxicity probably or possibly related to the topical administration of colistin was noted in five out of the 32 patients.
  
  
  CONCLUSIONS
  Topical colistin can be an effective and safe treatment for MDR Acinetobacter meningitis.
authors.affiliation: Tropical and Parasitological Diseases Unit, Department of Human Pathology, University of Messina, Via Consolare Valeria n. 1, 98125 Messina, Italy. acascio@unime.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Cascio
authors.forename: Alfredo
authors.initials: A
authors.lastname: Conti
authors.forename: Luca
authors.initials: L
authors.lastname: Sinardi
authors.forename: Chiara
authors.initials: C
authors.lastname: Iaria
authors.forename: Filippo Flavio
authors.initials: FF
authors.lastname: Angileri
authors.forename: Giovanna
authors.initials: G
authors.lastname: Stassi
authors.forename: Teresa
authors.initials: T
authors.lastname: David
authors.forename: Antonio
authors.initials: A
authors.lastname: Versaci
authors.forename: Maurizio
authors.initials: M
authors.lastname: Iaria
authors.forename: Antonio
authors.initials: A
authors.lastname: David
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003091:Colistin / Q000008:administration & dosage*; D006259:Craniocerebral Trauma / Q000601:surgery*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D011183:Postoperative Complications / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin