Intraventricular Tigecycline as a Last Resort Therapy in a Patient with Difficult-to-Treat Healthcare-Associated Acinetobacter baumannii Ventriculitis: a Case Report

Abstract

Healthcare-associated ventriculitis and meningitis is a common complication in patients who suffer from head trauma or have undergone a neurosurgery. Healthcare-associated ventriculitis and meningitis is associated with significant morbidity and mortality. Complications of healthcare-associated ventriculitis and meningitis include persistent vegetative state, moderate and severe disability, and death. Acinetobacter baumannii is the causative pathogen in 3.6–11.2% of cases of healthcare-associated ventriculitis and meningitis. Cases of difficult-to-treat healthcare-associated A. baumannii ventriculitis and meningitis are being reported more frequently. However, in most of these cases, a combination of intravenous (IV) and intraventricular (IVT)/intrathecal colistin achieves good therapeutic outcome. This report describes a clinical case of difficult-to-treat healthcare-associated A. baumannii ventriculitis. The A. baumannii strain was sensitive to colistin and trimethoprim-sulfamethoxazole, intermediate to tigecycline, and resistant to other antibiotics. While colistin was the drug of choice in our case, the patient developed anaphylactoid reaction during the IV administration of the loading dose of colistin, which mandated us to discontinue colistin and complicated the treatment of our patient. The patient did not respond to a combination of IV antibiotics that included meropenem, trimethoprim-sulfamethoxazole, and tigecycline. However, when IVT tigecycline was added as a last-resort therapeutic option, the patient’s ventriculitis dramatically improved, and the patient was discharged from the hospital. Physicians who treat patients with healthcare-associated A. baumannii ventriculitis might resort to IVT tigecycline when they run out of therapeutic options.

Intrathecal Injection of Tigecycline and Polymyxin B in the Treatment of Extensively Drug-Resistant Intracranial Acinetobacter baumannii Infection: A Case Report and Review of the Literature

“…IVT tigecycline seemed to be a safe treatment option. In recent years, some studies reported successful application of IVT/ITH tigecycline in patients 36 , 42–47 ( Table 3 ). IVT/ITH tigecycline was administered at doses of 3 to 20 mg per day, and one patient developed liver injury and another developed spinal arachnoiditis, which resolved after discontinuation of the antibiotic.…”

Virulence Potential and Treatment Options of Multidrug-Resistant (MDR) Acinetobacter baumannii

“…Clinical reports described the combination regimens of tigecycline to treat A. baumannii infections, such as bacteremia, VAP, soft tissue, and skin infections [ 126 , 167 ]. A poor correlation has been reported through studies between microbiological and clinical outcomes, mainly among patients under treatment for respiratory tract infections [ 120 , 168 , 169 ]. A low rate (48%) of microbiological eradication with tigecycline treatment has been noticed in A. baumannii hospital-acquired pneumonia (HAP) in some patients, probably due to the lack of adequate tigecycline concentration [ 170 ].…”

Ventriculitis: Infection or Inflammation

“…Some antibiotics, such as aminoglycosides, cannot be used intravenously for ventriculitis due to very limited CSF penetration. However, they have been successfully used via the intraventricular route, as demonstrated in small case series and case reports [84,85]. Apart from higher CSF levels, intraventricular administration of vancomycin for Staphylococcal ventriculitis results in a faster reduction in CSF pleocytosis and CSF sterilization [86].…”