title: Intra-Pleural Colistin Methanesulfonate Therapy for Pleural Infection caused by Carbapenem-Resistant Acinetobacter Baumannii: A Successful Case Report.
abstract: Infections caused by carbapenem-resistant, Gram-negative bacteria are an increasing clinical challenge, since the antimicrobial treatment options are often limited to colistin methanesulfonate. No data are available regarding the pharmacokinetics of colistin in pleural fluid. We report the case of a 92-year old man with ventilator-associated pneumonia and pleurisy caused by Acinetobacter baumannii and Escherichia coli, which were both multidrug-resistant. After an unsuccessful treatment with intravenous colistin methanesulfonate and imipen-em-cilastatin, the addition of intra-pleural colistin methanesulfonate to the intravenous treatment led to a prompt clinical, radiological and microbiological resolution. This is the first report of a successful use of intra-pleural colistin in the literature. The intra-pleural colistin therapy should be considered in selected cases of pleurisy caused by multi-resistant Gram-negative bacteria.
authors.affiliation: Intensive Care Medicine, King Saud Medical City , Riyadh.
authors.forename: Muhammad Asim
authors.initials: MA
authors.lastname: Rana
authors.affiliation: Intensive Care Medicine, King Saud Medical City , Riyadh.
authors.forename: Basheer Abd El
authors.initials: BA
authors.lastname: Rahman
authors.affiliation: Intensive Care Medicine, King Saud Medical City , Riyadh.
authors.forename: Ahmed Fouad
authors.initials: AF
authors.lastname: Mady
authors.affiliation: Intensive Care Medicine, King Saud Medical City , Riyadh.
authors.forename: Mohammed Al
authors.initials: MA
authors.lastname: Odat
authors.affiliation: Intensive Care Medicine, King Saud Medical City , Riyadh.
authors.forename: Abdurehman
authors.initials: A
authors.lastname: AlHarthy
authors.affiliation: Intensive Care Medicine, King Saud Medical City , Riyadh.
authors.forename: Omar El Sayed
authors.initials: Oel S
authors.lastname: Ramadan
authors.affiliation: Intensive Care Medicine, King Saud Medical City , Riyadh.
authors.forename: Shahzad Ahmed
authors.initials: SA
authors.lastname: Mumtaz
authors.affiliation: Division of Infectious Diseases, Prince Sultan Military Medical City , Riyadh, Saudi Arabia.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Omrani
keywords: Acinetobacter Baumannii; Colistemethate sodium; Colistin; Gram negative bacteria; intrapleural infection; multi drug resistant