title: Acinetobacter species meningitis in children: a case series from Karachi, Pakistan.
abstract: BACKGROUND
  Multidrug-resistant strains of Acinetobacter pose a serious therapeutic dilemma in hospital practice, particularly when they cause meningitis, as the few antimicrobial agents to which these isolates are susceptible have poor central nervous system (CNS) penetration.
  
  
  METHODS
  We retrospectively reviewed the clinical course and outcome of eight consecutive cases of meningitis due to Acinetobacter spp. in children ages 15 years or less, seen in a tertiary care medical center in Karachi, Pakistan.
  
  
  RESULTS
  Of the eight cases of Acinetobacter meningitis, isolates from five patients were pan-resistant, and two were multidrug-resistant. A neurosurgical procedure was performed in five of eight patients followed by external ventricular drain insertion prior to the development of infection. Seven received intravenous (IV) polymyxin (mean; 12.8 days), while 5/8 also received intrathecal (IT) polymyxin (mean; 12.0 days). The mean length of hospitalization was 38.7 ± 19 days. All patients achieved cerebrospinal fluid (CSF) culture negativity by the end of treatment (mean; 5.4 days). Two patients died: one with pan-resistant Acinetobacter, and the second with a multi-drug resistant isolate.
  
  
  CONCLUSIONS
  Post-neurosurgical multidrug-resistant and pan-resistant Acinetobacter meningitis can be successfully treated if appropriate antimicrobial therapy is instituted early. The role of IT polymyxin B administration alone versus combination therapy (IV and IT) needs further study.
authors: The Aga Khan University Hospital, Karachi, Pakistan. ali.saleem@aku.edu
authors: Ali Faisal
authors: AF
authors: Saleem
authors: Muhammad Shafaat
authors: MS
authors: Shah
authors: Abdul Sattar
authors: AS
authors: Shaikh
authors: Fatima
authors: F
authors: Mir
authors: Anita K M
authors: AK
authors: Zaidi
mesh_terms: D000150:Acinetobacter / Q000187:drug effects / Q000302:isolation & purification*; D000151:Acinetobacter Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D004322:Drainage / Q000009:adverse effects; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D010154:Pakistan; D011113:Polymyxins / Q000627:therapeutic use; D011183:Postoperative Complications; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011113:Polymyxins