title: Intraventricular versus intravenous colistin for the treatment of extensively drug resistant Acinetobacter baumannii meningitis.
abstract: OBJECTIVE
  Reports on the safety and efficacy of intraventricularly administered (IVT) colistin for the treatment of Acinetobacter baumannii ventriculomeningitis in adults are limited and no comparative studies of IVT colistin versus intravenous (IV) therapy alone have been published. This study compared outcomes of patients with postneurosurgical ventriculomeningitis caused by extensively drug-resistant A. baumannii treated with IV colistin or IV plus IVT colistin.
  
  
  METHODS
  In an 11-year period, information on 18 consecutive patients with extensively drug-resistant A. baumannii ventriculomeningitis was collected. Infection was defined on the basis of (i) isolation of A. baumannii from the cerebrospinal fluid (CSF); (ii) laboratory evidence of CSF infection; (iii) signs/symptoms of central nervous system (CNS) infection. Patients were divided into group 1 (nine patients, IV colistin alone) and group 2 (nine patients, IV plus IVT colistin).
  
  
  RESULTS
  Cerebrospinal fluid sterilization was documented for 12 of 18 patients (66.6%). The CSF sterilization rate was 33.3% in group 1 and 100% in group 2 (P = 0.009). The mean time to CSF sterilization was 21 days (range 8-48). Five patients died due to A. baumannii CNS infection (all in group 1), and five deaths were unrelated to A. baumannii ventriculomeningitis. Intensive care unit mean length of stay was shorter in group 2 (20.7 vs. 41.6 days, P = 0.046). Crude relative risk ratio of cumulative incidence of persistent CNS infection in group 1 versus group 2 was 13. No cases of chemical meningitis due to intrathecal colistin administration were encountered.
  
  
  CONCLUSIONS
  Intraventricular colistin administration is much more effective than IV therapy alone and does not seem to add further toxicity.
authors.affiliation: Neurosurgery, Catholic University School of Medicine, Rome, Italy.|Neurosurgery, University Hospital S. Anna, Ferrara, Italy.
authors.forename: P
authors.initials: P
authors.lastname: De Bonis
authors.affiliation: Neurosurgery, Catholic University School of Medicine, Rome, Italy.
authors.forename: G
authors.identifier: http://orcid.org/0000-0001-5874-7340
authors.initials: G
authors.lastname: Lofrese
authors.affiliation: Infectious Diseases, Catholic University School of Medicine, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Scoppettuolo
authors.affiliation: Microbiology, Catholic University School of Medicine, Rome, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Spanu
authors.affiliation: Infectious Diseases, University Hospital S. Anna, Ferrara, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Cultrera
authors.affiliation: Department of Laboratory Medicine and Transfusion Medicine, Hospital for Research and Care Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Labonia
authors.affiliation: Neurosurgery, University Hospital S. Anna, Ferrara, Italy.
authors.forename: M A
authors.initials: MA
authors.lastname: Cavallo
authors.affiliation: Neurosurgery, Catholic University School of Medicine, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mangiola
authors.affiliation: Neurosurgery, Catholic University School of Medicine, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Anile
authors.affiliation: Neurosurgery, Catholic University School of Medicine, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pompucci
mesh_terms: D000151:Acinetobacter Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D003091:Colistin / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D057967:Infusions, Intraventricular; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin
keywords: Acinetobacter; colistin; intraventricular therapy; meningitis; ventriculitis