Cure of multiresistant Acinetobacter baumannii central nervous system infections with intraventricular or intrathecal colistin: case series and literature review

• Published in: Journal of antimicrobial chemotherapy Vol. 58; no. 5; pp. 1078 - 1081
• Main Authors: Ng, John, Gosbell, Iain B., Kelly, John A., Boyle, Michael J., Ferguson, John K.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.11.2006; Oxford Publishing Limited (England)
• Subjects: A. baumannii; Acinetobacter baumannii; Acinetobacter baumannii - isolation & purification; Acinetobacter Infections - drug therapy; Acinetobacter Infections - microbiology; Adult; Aged; Anti-Bacterial Agents - administration & dosage; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Central Nervous System Bacterial Infections - drug therapy; Central Nervous System Bacterial Infections - microbiology; Chemotherapy; Child, Preschool; CNS infections; Colistin - administration & dosage; Drug Resistance; Drug therapy; Female; Humans; Infections; injections; Injections, Intraventricular; Injections, Spinal; Male; Medical sciences; meningitis; Microbiology; Middle Aged; Neurosurgery; Pharmacology; Pharmacology. Drug treatments; polymyxin E; ventriculitis; Colistin; Cyclic peptides; Neisseriaceae; Central nervous system; polymyxin E; Ventriculitis; Multiple resistance; Bacteria; Micrococcales; Meningitis; Intrathecal; A. baumannii; injections; Nervous system diseases; Cure; CNS infections; Cerebral ventricle; Intrathecal administration; Infection; Acinetobacter baumannii; Antibiotic; Polypeptide; Central nervous system disease; Antibacterial agent; Bibliographic review
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkl347

Objectives: CNS infections due to multiresistant Acinetobacter baumannii (MRAB) are an emerging problem in neurosurgical patients. Colistin remains one of the few remaining treatment options for MRAB but has poor CNS penetration. We describe our experience with intraventricular or intrathecal colistin for this infection. Methods: Cases known to have received intraventricular or intrathecal colistin for CNS infections due to MRAB were retrospectively reviewed regarding colistin treatment, colistin efficacy and adverse events. Results: Five patients were identified. All were admissions to the neurosurgical ICU and all were cured of their CNS infections. Three cases were complicated by drug-induced aseptic meningitis or ventriculitis. Conclusions: This largest case series to date shows that direct instillation of colistin into the CNS may cause chemical meningitis or ventriculitis but it is an effective treatment option for MRAB CNS infection. Further study of dosing regimens is needed.