title: Extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacter cloacae ventriculitis successfully treated with intraventricular colistin.
abstract: We present a case of post-neurosurgical ventriculitis caused by carbapenemase-producing Enterobacter cloacae successfully treated with intraventricular colistin. Enterobacter spp are intrinsically resistant to aminopenicillins, cefazolin, and cefoxitin due to the production of constitutive chromosomal AmpC beta-lactamases. Moreover, extended-spectrum beta-lactamase-producing Enterobacter spp have been identified in the USA and Europe, and carbapenems are considered the drug of choice in these cases. Our isolate was sensitive only to fosfomycin, tigecycline, and colistin, and 6 days of intravenous colistin had failed to eradicate the infection. This case provides clinical evidence to support the administration of intraventricular colistin in such patients.
authors.affiliation: Department of Human Pathology, University of Messina, Via Consolare Valeria n. 1, 98125 Messina, Italy. Electronic address: acascio@unime.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cascio
authors.affiliation: Department of Biomedical Sciences, Section of Microbiology, University of Catania, Catania, Italy.
authors.forename: Maria Lina
authors.initials: ML
authors.lastname: Mezzatesta
authors.affiliation: Neurosurgery Unit, ARNAS General Hospital "Civico, Di Cristina, Benfratelli", Palermo, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Odierna
authors.affiliation: Laboratory of Microbiology, ARNAS General Hospital "Civico, Di Cristina e Benfratelli", Palermo, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Bernardo
authors.affiliation: Department of Human Pathology, University of Messina, Via Consolare Valeria n. 1, 98125 Messina, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Barberi
authors.affiliation: Infectious Diseases Unit, Azienda Ospedaliera Piemonte-Papardo, Messina, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Iaria
authors.affiliation: Department of Biomedical Sciences, Section of Microbiology, University of Catania, Catania, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Stefani
authors.affiliation: Infectious Diseases Unit, ARNAS General Hospital "Civico, Di Cristina, Benfratelli", Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Giordano
mesh_terms: D061605:Administration, Intravenous; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000378:metabolism; D002442:Ceftazidime / Q000627:therapeutic use; D058565:Cerebral Ventriculitis / Q000188:drug therapy*; D002675:Child, Preschool; D003091:Colistin / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D016972:Enterobacter cloacae / Q000145:classification / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D017334:Teicoplanin / Q000627:therapeutic use; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D017334:Teicoplanin; D000583:Amikacin; D002442:Ceftazidime; D001618:beta-Lactamases; C063912:carbapenemase; D003091:Colistin
keywords: Carbapenemases; Colistin; Enterobacter cloacae; Enterobacteriaceae; Intraventricular; Meningitis; Ventriculitis