title: Variables determining mortality in patients with Acinetobacter baumannii meningitis/ventriculitis treated with intrathecal colistin.
abstract: OBJECTIVE
  To examine the variables associated with mortality in patients with Acinetobacter baumannii-related central nervous system infections treated with intrathecal colistin.
  
  
  METHODS
  This multi-centre retrospective case control study included patients from 11 centres in Turkey, as well as cases found during a literature review. Only patients with CNS infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii treated with intrathecal colistin were included in this study. The variables associated with mortality were determined by dividing the patients into groups who died or survived during hospitalisation, and who died or survived from Acinetobacter meningitis.
  
  
  RESULTS
  Among the 77 cases enrolled in the study, 35 were found through a literature review and 42 were cases from our centres. Forty-four cases (57.1%) were male and the median age was 48 years (range: 20-78 years). Thirty-seven patients (48%) died during hospitalisation. The variables associated with increased all-cause mortality during hospitalisation included old age (odds ratio, 1.035; 95% confidence interval (CI), 1.004-1.067; p=0.026) and failure to provide cerebrospinal fluid sterilisation (odds ratio, 0.264; 95% confidence interval, 0.097-0.724; p=0.01). There is a trend (P=0.062) towards higher mortality with using of meropenem during meningitis treatment. Fifteen cases (19%) died from meningitis. There were no significant predictors of meningitis-related mortality.
  
  
  CONCLUSIONS
  The mortality rate for central nervous system infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii is high. Old age and failure to provide CSF sterilisation are associated with increased mortality during hospitalisation.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medipol University, Turkey.
authors.forename: Bahadır
authors.initials: B
authors.lastname: Ceylan
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey. Electronic address: ferhatarslandr@hotmail.com.
authors.forename: Ferhat
authors.initials: F
authors.lastname: Arslan
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.
authors.forename: Oguz Resat
authors.initials: OR
authors.lastname: Sipahi
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, 19 Mayıs University, Samsun, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Sunbul
authors.affiliation: Department of Infectious Disease and Clinical Microbiology, Atatürk Education and Training Hospital, Izmir, Turkey.
authors.forename: Bahar
authors.initials: B
authors.lastname: Ormen
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine,Vakıf Gureba Bezmi Alem University, Istanbul, Turkey.
authors.forename: İsmail N
authors.initials: İN
authors.lastname: Hakyemez
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Baskent University, Adana, Turkey.
authors.forename: Tuba
authors.initials: T
authors.lastname: Turunc
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey.
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Yıldız
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Harran University, Şanlıurfa, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Karsen
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Umraniye Education and Training Hospital, Istanbul, Turkey.
authors.forename: Gul
authors.initials: G
authors.lastname: Karagoz
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.
authors.forename: Recep
authors.initials: R
authors.lastname: Tekin
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.
authors.forename: Burcu
authors.initials: B
authors.lastname: Hizarci
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Sultan Abdulhamid Education and Training Hospital, Istanbul, Turkey.
authors.forename: Vedat
authors.initials: V
authors.lastname: Turhan
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
authors.forename: Sebnem
authors.initials: S
authors.lastname: Senol
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Antalya Education and Training Hospital, Antalya, Turkey.
authors.forename: Nefise
authors.initials: N
authors.lastname: Oztoprak
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medipol University, Turkey.
authors.forename: Mesut
authors.initials: M
authors.lastname: Yılmaz
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
authors.forename: Kevser
authors.initials: K
authors.lastname: Ozdemir
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Mermer
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Sutcu Imam University, Kahramanmaras, Turkey.
authors.forename: Omer F
authors.initials: OF
authors.lastname: Kokoglu
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medipol University, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Mert
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000401:mortality*; D040981:Acinetobacter baumannii / Q000472:pathogenicity*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D016022:Case-Control Studies; D058565:Cerebral Ventriculitis / Q000453:epidemiology / Q000401:mortality*; D003091:Colistin / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology / Q000401:mortality*; D000077731:Meropenem; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013845:Thienamycins / Q000008:administration & dosage / Q000494:pharmacology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem; D003091:Colistin
keywords: Acinetobacter baumannii; Colistin; Intratechal; Meningitis