Post-neurosurgical multidrug-resistant Acinetobacter baumannii meningitis successfully treated with intrathecal colistin. A new case and a systematic review of the literature.
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.
Cascio
Antonio
A
Tropical and Parasitological Diseases Unit, Department of Human Pathology, University of Messina, Via Consolare Valeria n. 1, 98125 Messina, Italy. acascio@unime.it
Conti
Alfredo
A
Sinardi
Luca
L
Iaria
Chiara
C
Angileri
Filippo Flavio
FF
Stassi
Giovanna
G
David
Teresa
T
Versaci
Antonio
A
Iaria
Maurizio
M
David
Antonio
A
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
D000900:Anti-Bacterial Agents; D003091:Colistin