Colistin-Resistant Acinetobacter baumannii as a cause of Neonatal Ventriculitis

Mahabeer, Prasha; Mzimela, B W; Lawler, Melissa A.; Singh-Moodley, Ashika; Singh, Rachna; Mlisana, Koleka

doi:10.4102/sajid.v33i5.141

Cited by 6 publications

(10 citation statements)

References 7 publications

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“…In another review, Katragkou et al discussed the treatment of MDR A. baumannii -associated CNS infection by using IVT/IT colistin alone or as an adjunctive to systemic antimicrobials ( 55 ). In our study, neonatal CSF became sterile within an average of 3.72 days (range 2–8 days), which is similar to earlier literature ( 56 , 57 ). Previous adult and pediatric studies have concluded that the use of IT/IVT colistin was found safe and effective ( 56 , 57 ).…”

Section: Discussionsupporting

confidence: 92%

“…In our study, neonatal CSF became sterile within an average of 3.72 days (range 2–8 days), which is similar to earlier literature ( 56 , 57 ). Previous adult and pediatric studies have concluded that the use of IT/IVT colistin was found safe and effective ( 56 , 57 ).…”

Section: Discussionsupporting

confidence: 92%

“…In addition, combination therapy with colistin, meropenem, and ampicillin-sulbactam has been reported to reduce the mortality rate ( 21 ). Colistin resistance among A. baumannii and K. pneumonia are increasingly reported and a case report from South Africa identified the presence of colistin-resistant A baumannii -associated ventriculitis in a neonate ( 56 ). Another case report by Mehar et al .…”

Section: Discussionmentioning

confidence: 99%

“…The increasing prevalence of MDRO causing neonatal sepsis including meningitis and ventriculitis in some middle- and low-income countries is a matter of great concern ( 41 , 56 ). Also, the implementation of infection control and prevention strategies is a global challenge in these regions to control the spread of MDR-GNB.…”

Section: Discussionmentioning

confidence: 99%

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Neurodevelopment Outcome of Neonates Treated With Intraventricular Colistin for Ventriculitis Caused by Multiple Drug-Resistant Pathogens—A Case Series

et al. 2021

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Background: Multiple-drug-resistant Gram-negative bacteria (MDR-GNB)-associated neonatal ventriculitis is a life-threatening complication that needs timely diagnosis and effective treatment with broad-spectrum antimicrobials in critical-care settings. Inadequate penetration of antibiotics through the blood–brain barrier also demands an intraventricular (IVT) route of administration. This study reports mortality and neurodevelopmental sequelae of neonates till 18 months of age, who received IVT-colistin for treating MDR-GNB associated ventriculitis.Methods: In a case series of seven neonates with ventriculitis due to MDR-GNB at NICU of Aga Khan University Hospital, Pakistan, between June 2015 and 2018, we reviewed IVT-colistin therapy in critically ill neonates. Treatment outcomes were assessed based on clinical sign's resolution and MDR-GNB eradication in subsequent CSF cultures. Neurodevelopmental outcomes were evaluated at 18 months after discharge.Results: The average birth weight was 1.38 kg (range: 1.02–1.5 kg), and the average gestational age was 30.7 weeks (ranged: 26–34 weeks). All neonates reported colistin-sensitive MDR-GNB in CSF, five with Acinetobacter baumannii, and polymicrobial CNS infection was found in two patients (one due to Klebsiella pneumonia and A. baumannii and one due to K. pneumonia and Escherichia coli). All neonates received IVT colistin and concomitant intravenous meropenem, and five of them also received intravenous colistin. One neonate died. At the 18-month assessment, only one neonate had cerebral palsy and hydrocephaly and 50% had seizure disorders.Conclusion: Practicing intraventricular antibiotics in the neonatal population is challenging but may be used successfully, especially to overcome the limitation of poor penetration through the blood–brain barrier.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Neurodevelopment Outcome of Neonates Treated With Intraventricular Colistin for Ventriculitis Caused by Multiple Drug-Resistant Pathogens—A Case Series

et al. 2021

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“…The six colistin-resistant isolates that underwent WGS were also negative for the mcr-1 to mcr-10 genes (all the tested isolates in this study were PCR negative for the mcr-1 to mcr-5 genes). Currently, in South Africa, colistin resistance is not attributed to any of the plasmid-borne mcr genes (Perovic and Chetty, 2016;Mahabeer et al, 2018;Snyman et al, 2020;Nogbou et al, 2022). It is nevertheless still important to monitor and test for the mcr genes in A. baumannii isolates as they can easily be transferred between bacterial species (Gogry et al, 2021).…”

Section: Resistancenodulation-division Adeabc and Adefghmentioning

confidence: 99%

Molecular characterisation of Acinetobacter baumannii isolates from bloodstream infections in a tertiary-level hospital in South Africa

et al. 2022

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Acinetobacter baumannii is an opportunistic pathogen and causes various infections in patients. This study aimed to describe the clinical, epidemiological and molecular characteristics of A. baumannii isolated from BCs in patients at a tertiary-level hospital in South Africa. Ninety-six isolates from bloodstream infections were collected. Clinical characteristics of patients were recorded from patient files. Organism identification and AST was performed using automated systems. PCR screening for the mcr-1 to mcr-5 genes was done. To infer genetic relatedness, a dendrogram was constructed using MALDI-TOF MS. All colistin-resistant isolates (n = 9) were selected for WGS. The patients were divided into three groups, infants (<1 year; n = 54), paediatrics (1–18 years; n = 6) and adults (≥19 years; n = 36) with a median age of 13 days, 1 and 41 years respectively. Of the 96 A. baumannii bacteraemia cases, 96.9% (93/96) were healthcare-associated. The crude mortality rate at 30 days was 52.2% (48/92). The majority of the isolates were multidrug-resistant (MDR). All isolates were PCR-negative for the mcr-1 to mcr-5 genes. The majority of the isolates belonged to cluster 1 (62/96) according to the MALDI-TOF MS dendrogram. Colistin resistance was confirmed in nine A. baumannii isolates (9.4%). The colistin-resistant isolates belonged to sequence type (ST) 1 (5/6) and ST2 (1/6). The majority of ST1 isolates showed low SNP diversity (≤4 SNPs). All the colistin-resistant isolates were resistant to carbapenems, exhibited an XDR phenotype and harboured the blaOXA–23 gene. The blaNDM gene was only detected in ST1 colistin-resistant isolates (n = 5). The lpsB gene was detected in all colistin-resistant isolates as well as various efflux pump genes belonging to the RND, the MFS and the SMR families. The lipooligosaccharide OCL1 was detected in all colistin-resistant ST1 and ST2 isolates and the capsular polysaccharide KL3 and KL17 were detected in ST2 and ST1 respectively. This study demonstrated a 9.4% prevalence of colistin-resistant ST1 and ST2 A. baumannii in BC isolates. The detection of the lpsB gene indicates a potential threat and requires close prospective monitoring.

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Challenges in Diagnosis and Treatment of Neonatal Ventriculitis: A Case Report and Systematic Review of Difficult-to-Treat Central Nervous System Infection Resistant to Conventional Therapy

Ongun,

Kihtir,

Zarif

et al. 2024

J Pediatr Infect Dis

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Objective Ventriculitis is an example of the increasing global trend in difficult-to-treat infections in neonates caused by pathogens resistant to conventional therapies. This article describes the first use of intravenous and intraventricular tigecycline to treat ventriculitis caused by vancomycin-resistant enterococci in a preterm neonate and systematically review the literature on challenges posed by the definitions, diagnosis, and treatment of neonatal ventriculitis Methods The authors searched PubMed and Internet search engines for “ventriculitis” in the period from 2003 to 2023 restricting the research to “Newborn,” “Human,” “English language,” and “full-text availability.” Results Thirty-seven publications (20 case reports, 6 case series, and 11 research articles) were extracted upon research. Preterm birth, posthemorrhagic ventricular dilatation requiring placement of ventricular access devices, and sepsis preceded neonatal ventriculitis. Infections caused by rare microorganisms, in particular gram-negative bacteria resistant to conventional therapies, predominated in the publications describing the need for a combination of intravenous (IV) and intraventricular (IVT) therapies. Survivors of neonatal ventriculitis developed neurodevelopmental impairments such as hydrocephalus, seizures, motor function, hearing, and vision impairment. Conclusion Clinical suspicion of ventriculitis indicated by subtle signs is key for prompt diagnosis. Effective IV and IVT antibiotics are essential to prevent serious sequelae and mortality. The drug delivery method should be changed if there is no clinical response. This study emphasizes the urgent need for pediatric trials of antibiotics against organisms resistant to other drugs.

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Colistin-Resistant Acinetobacter baumannii as a cause of Neonatal Ventriculitis

Cited by 6 publications

References 7 publications

Neurodevelopment Outcome of Neonates Treated With Intraventricular Colistin for Ventriculitis Caused by Multiple Drug-Resistant Pathogens—A Case Series

Neurodevelopment Outcome of Neonates Treated With Intraventricular Colistin for Ventriculitis Caused by Multiple Drug-Resistant Pathogens—A Case Series

Molecular characterisation of Acinetobacter baumannii isolates from bloodstream infections in a tertiary-level hospital in South Africa

Challenges in Diagnosis and Treatment of Neonatal Ventriculitis: A Case Report and Systematic Review of Difficult-to-Treat Central Nervous System Infection Resistant to Conventional Therapy

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