Multidrug-resistant Acinetobacter baumannii ventriculitis: successful treatment with intraventricular colistin

Abstract

Acinetobacter baumannii has emerged as an important nosocomial pathogen that can cause a multitude of severe infections. In neurosurgical patients the usual presentation is ventriculitis associated with external ventricular drainage. Carbapenems have been considered the gold standard for the treatment of Acinetobacter baumannii ventriculitis, but resistant isolates are increasing worldwide, reducing the therapeutic options. In many cases polymyxins are the only possible alternative, but their poor blood-brain barrier penetration could require them to be directly administered intraventricularly and clinical experience with this route is limited. We review the literature concerning intraventricular use of colistin (polymyxin E) for A. baumannii ventriculitis and add three cases successfully treated with this method. Our experience suggests that intraventricular colistin is a potentially effective and safe therapy for the treatment of multidrug-resistant A. baumannii central nervous system infections.

Active efflux pump adeB is involved in multidrug resistance of Acinetobacter baumannii induced by antibacterial agents

“…baumannii, which is a gram-negative, non-fermentative coccobacillus of the family Moraxellaceae, is considered to be an important cause of ventilator-associated pneumonia, sepsis, urinary system infection and meningitis (11)(12)(13)(14)(15)(16)(17) (18). We speculated that this descrepency may be due to the strains selected in this study.…”

Colistin: an update on the antibiotic of the 21st century

“…Colistin has also been used recently to treat ventilator-associated pneumonia (VAP) and bacteremia caused by MDR bacteria, such as P. aeruginosa, K. pneumoniae and A. baumannii [ [133] and Dalgic et al [134] suggested that intraventricular administration of CMS is effective for the treatment of ventriculitis caused by MDR A. baumannii.…”

Colistin in the 21st century

“…First, for those clinicians referring to published reports of studies involving CMS/colistin to guide their practice, insufficient detail is often provided in published papers to ascertain the doses of CMS actually used. Confusion regarding this is illustrated in a recent review [19] of intraventricular CMS for treatment of A. baumannii ventriculitis, where doses of CMS were tabulated in mg but for a product labeled with ‘colistin base activity’ [20] it was not clear whether the mg of ‘colistin base activity’ had been converted to mg of CMS). The second unresolved issue is the most appropriate daily dose.…”

“…The intrathecal or intraventricular administration of CMS to treat CNS infections has been reviewed previously [6, 8, 57] and reports continue to accumulate [19, 58]. Administration via these routes is usually instituted when there is concern that intravenous CMS will adequately penetrate into site of infection or when intravenous administration has actually been shown to be ineffective.…”

“…Administration via these routes is usually instituted when there is concern that intravenous CMS will adequately penetrate into site of infection or when intravenous administration has actually been shown to be ineffective. Recently, it has been suggestedthat intraventricular administration of CMS is effective for the treatment of ventriculitis caused by MDR A. baumannii [19, 58]. It is interesting that this treatment appears to be remarkably well tolerated although chemical ventriculitis, chemical meningitis and seizures have been reported in some patients [19].…”