title: Management of Meningitis Caused by Multi Drug-Resistant Acinetobacter Baumannii: Clinical, Microbiological and Pharmacokinetic Results in a Patient Treated with Colistin Methanesulfonate.
abstract: This paper reports on a 71- year-old Caucasian male who underwent neurosurgery for an oligodendroglioma, followed by a cranial-sinus fistula and cerebrospinal fluid rhinorrhea. The clinical course was complicated due to an extensively drug-resistant Acinetobacter baumannii meningitis. The patient was treated with colistin methanesulfonate, intrathecal for 24 days and intravenous for 46 days. In addition, the patient received meropenem and teicoplanin to treat a urinary tract infection and a bacterial aspiration pneumonia. Cerebrospinal fluid trough colistin levels resulted above the MIC of A. baumannii. Colistin cerebrospinal fluid concentration did not increase over the treatment period. Meningitis was cured and A. baumannii eradicated. No side effects from the antimicrobial therapy were observed. In conclusion, this case highlights the issues in treating infections caused by resistant Gram negative bacteria and supports previous findings on the efficacy, pharmacokinetic and tolerability of intravenous and intrathecal colistin treatments.
authors.affiliation: Unit of Infectious Diseases, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Schiaroli
authors.affiliation: Unit of Infectious Diseases, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: Maria Bruna
authors.initials: MB
authors.lastname: Pasticci
authors.affiliation: Department of Health Science, University of Florence, Florence, Italy.
authors.forename: Maria Iris
authors.initials: MI
authors.lastname: Cassetta
authors.affiliation: Department of Health Science, University of Florence, Florence, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Fallani
authors.affiliation: Unit of Neurosurgery, Hospital Santa Maria della Misericordia, Perugia, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Castrioto
authors.affiliation: Unit of of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Pirro
authors.affiliation: Department of Health Science, University of Florence, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Novelli
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Henrici De Angelis
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy.
authors.forename: Marco Maria
authors.initials: MM
authors.lastname: D'Andrea
authors.affiliation: Department of Biomedical and Biotechnological Sciences, University of Catania, Catania Italy.
authors.forename: Maria Lina
authors.initials: ML
authors.lastname: Mezzatesta
authors.affiliation: Unit of Infectious Diseases, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Baldelli
authors.affiliation: Unit of Microbiology, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Mencacci