Acinetobacter species meningitis in children: a case series from Karachi, Pakistan

Abstract

Introduction: Multidrug-resistant strains of Acinetobacter pose a serious therapeutic dilemma in hospital practice, particularly when they cause meningitis, as the few antimicrobial agents to which these isolates are susceptible have poor central nervous system (CNS) penetration. Methodology: We retrospectively reviewed the clinical course and outcome of eight consecutive cases of meningitis due to Acinetobacter spp. in children ages 15 years or less, seen in a tertiary care medical center in Karachi, Pakistan. Results: Of the eight cases of Acinetobacter meningitis, isolates from five patients were pan-resistant, and two were multidrug-resistant. A neurosurgical procedure was performed in five of eight patients followed by external ventricular drain insertion prior to the development of infection. Seven received intravenous (IV) polymyxin (mean; 12.8 days), while 5/8 also received intrathecal (IT) polymyxin (mean; 12.0 days). The mean length of hospitalization was 38.7 ± 19 days. All patients achieved cerebrospinal fluid (CSF) culture negativity by the end of treatment (mean; 5.4 days). Two patients died: one with pan-resistant Acinetobacter, and the second with a multi-drug resistant isolate. Conclusion: Post-neurosurgical multidrug-resistant and pan-resistant Acinetobacter meningitis can be successfully treated if appropriate antimicrobial therapy is instituted early. The role of IT polymyxin B administration alone versus combination therapy (IV and IT) needs further study.

A Prospective Study on Prevalence and Antibiotic Susceptibility Pattern of Acinetobacter baumannii in Clinical Samples obtained from Patients admitted in Various Wards and Intensive Care Units

“…In our study, the percentage of A. baumannii (83.33%) and other Acinetobacter species (16.67%) is found to be approximately similar in the studies by Fayyaz et al 27 and Gupta et al 29 In the present study, the percentage of Acinetobacter species in male (75.36%) and female (24.28%) is found to be approximately similar in the studies by Fayyaz et al 27 and higher than the studies by Tahseen and Talib 30 and Saleem et al 31 In our study, 1 patient was transgender admitted in pediatric ward. In the present study, the maximum frequency of Acinetobacter isolates from respiratory tract intubated patients (ET samples: 59.5%) followed by sputum (14.13%), pus swab c/s (13.40%), urine (4.35%), and blood (2.54%), which is higher than in the studies by Chim et al, 32 Markogiannakis et al, 22 and Alvarez-Lerma et al 33 In the present study, the maximum frequency of A. baumannii isolates was recovered from ICUs (63.04%) compared with wards, which is found to be similar in the studies by Xia et al 13 and Tahseen and Talib.…”

Post Neurosurgical Meningitis due to Colistin Heteroresistant Acinetobacter baumannii

“…The two isolates were sensitive to ampicillin-sulbactam in vitro and we used this antibiotic for treatment, but the patient did not respond to this antibiotic either. Tigecycline has in vitro activity on pan-drug resistant acinetobacter and some studies reported successful treatment of meningitis caused by multidrug resistant A. baumannii with tigecycline, yet this treatment option is very expensive and is not easily available in developing countries ( 23 , 24 ). Moreover, our isolates were susceptible to tigecycline in vitro , but tigecycline is not available in Iran.…”

Efficacy of colistin in multidrug-resistant neonatal sepsis: experience from a tertiary care center in Karachi, Pakistan

“…Colistin (base) was administered intravenously at a dose of 2.5–5.0 mg (75 000–150 000 units)/kg/day in two to four divided doses, 4 mg/kg/dose twice daily via nebulisation and 0.16–0.24 mg/kg as a single daily dose via intrathecal/intraventricular route. Doses were adjusted in patients with reduced renal function 27–29. All intravenous and intrathecal doses were dispensed in prefilled ready to administer form in normal saline and infused over 30 min.…”