Infect Chemother.  2009 Aug;41(4):240-244. 10.3947/ic.2009.41.4.240.

A Case of Multidrug-resistant Acinetobacter baumannii Ventriculitis Successfully Treated with Intrathecal Colistimethate

• Hong YA
• Yoo JH
• Kim JJ
• Mo EY
• Ahn GH
• Jeong HK
• Kim JS
• Lee HJ
• Jung MH
• Yoon SB

• KMID: 1473674
• DOI: http://doi.org/10.3947/ic.2009.41.4.240

Abstract

Acinetobacter species is a non-fermentative aerobic gram-negative coccobacillus that is an important pathogen found in nosocomial infections. Recently, multi-drug resistant Acinetobacter baumannii (MDR-AB) infections have been increasing and pose a serious problem. Most such infections present as bacteremia, pneumonia, or a wound infection; however, CNS infections are very rare. We herein present a case of ventriculitis caused by MDR-AB in a 37-year old man after a neurosurgical intervention. The patient was successfully treated with intrathecal colistimethate.

Keyword

Acinetobacter; Colistimethate sodium (colistin); CNS infection

MeSH Terms

Acinetobacter
Acinetobacter baumannii
Bacteremia
Colistin
Cross Infection
Humans
Pneumonia
Colistin

Figure

• 

  Fig. 1 Gram stain on CSF showed numerous gram negative cocobacilli that were identified as Acinetobacter baumannii (Cerebrospinal fluid, H&E stain, ×1,000).

Reference

1. Bergogne-Bérézin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev. 1996. 9:148–165.

2. Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med. 2003. 29:471–475.

3. Jawad A, Heritage J, Snelling AM, Gascoyne-Binzi DM, Hawkey PM. Influence of relative humidity and suspending menstrua on survival of Acinetobacter spp. on dry surfaces. J Clin Microbiol. 1996. 34:2881–2887.

4. Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis. 2006. 42:692–699.

5. Fernandez-Viladrich P, Corbella X, Corral L, Tubau F, Mateu A. Successful treatment of ventriculitis due to carbapenem-resistant Acinetobacter baumannii with intraventricular colistin sulfomethate sodium. Clin Infect Dis. 1999. 28:916–917.

6. Vasen W, Desmery P, Ilutovich S, Di Martino A. Intrathecal use of colistin. J Clin Microbiol. 2000. 38:3523.

7. Ho YH, Wang LS, Chao HJ, Chang KC, Su CF. Successful treatment of meningitis caused by multidrug-resistant Acinetobacter baumannii with intravenous and intrathecal colistin. J Micobiol Immunol Infect. 2007. 40:537–540.

8. Katragkou A, Roilides E. Successful treatment of multidrug resistant Acinetobacter baumannii central nervous system infections with colistin. J Clin Microbiol. 2005. 43:4916–4917.

9. Ng J, Gosbell IB, Kelly JA, Boyle MJ, Ferguson JK. Cure of multiresistant Acinetobacter baumannii central nervous system infections with intraventricular or intrathecal colistin: case series and literature review. J Antimicrob Chemother. 2006. 58:1078–1081.

10. Seifert H, Richter W, Pulverer G. Clinical and bacteriological features of relapsing shunt-associated meningitis due to Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis. 1995. 14:130–134.

11. Bonomo RA, Szabo D. Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa. Clin Infect Dis. 2006. 43:Suppl 2. 49–56.

12. Falagas ME, Kasiakou SK. Colistin: the revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections. Clin Infect Dis. 2005. 40:1333–1341.

13. Benedict RG, Langlykke AF. Antibiotic activity of Bacillus polymyxa. J Bacteriol. 1947. 54:24–25.

14. Wang KW, Chang WN, Huang CR, Tsai NW, Tsui HW, Wang HC, Su TM, Rau CS, Cheng BC, Chang CS, Chuang YC, Liliang PC, Tsai YD, Lu CH. Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes. J Clin Neurosci. 2005. 12:647–650.

15. Kunin CM, Bugg A. Binding of polymyxin antibiotics to tissues: the major determinant of distribution and persistence in the body. J Infect Dis. 1971. 124:394–400.

16. Craig WA, Kunin CM. Significance of serum protein and tissue binding of antimicrobial agents. Ann Rev Med. 1976. 27:287–300.

17. Jiménez-Mejías ME, Pichardo-Guerrero C, Máquez-Rivas FJ, Martín-Lozano D, Prados T, Pachón J. Cerebrospinal fluid penetration and pharmacokinetic/pharmacodynamic parameters of intravenously administered colistin in a case of multidrug-resistant Acinetobacter baumannii meningitis. Eur J Clin Microbiol Infect Dis. 2002. 21:212–214.