Outcomes of adjunctive therapy with intrathecal or intraventricular administration of colistin for post-neurosurgical meningitis and ventriculitis due to carbapenem-resistant acinetobacter baumannii

Chusri, Sarunyou; Sakarunchai, Ittichai; Kositpantawong, Narongdet; Panthuwong, Siripen; Santimaleeworagun, Wichai; Pattharachayakul, Sutthiporn; Singkhamanan, Kamonnut; Doi, Yohei

doi:10.1016/j.ijantimicag.2017.12.002

Cited by 37 publications

(35 citation statements)

References 19 publications

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“…The previously available studies on postneurosurgical MDR/XDR Acinetobacter meningitis/ventriculitis are mostly case reports or small case series. 1,2,10 This in turn reflects the very high burden of nosocomial meningitis/ventriculitis in developing countries like India. Our study is unique as it has clearly demonstrated the factors associated with mortality following postneurosurgical Acinetobacter meningitis/ventriculitis.…”

Section: Discussionmentioning

confidence: 99%

Outcome following postneurosurgical Acinetobacter meningitis: an institutional experience of 72 cases

Sharma¹,

Goda²,

Borkar³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe authors aimed to evaluate the antimicrobial susceptibility pattern of Acinetobacter isolates responsible for nosocomial meningitis/ventriculitis in the neurosurgical ICU. The authors also sought to identify the risk factors for mortality following Acinetobacter meningitis/ventriculitis.METHODSThis was a retrospective study of 72 patients admitted to the neurosurgical ICU between January 2014 and December 2018 with clinical and microbiological diagnosis of nosocomial postneurosurgical Acinetobacter baumanii meningitis/ventriculitis. Electronic medical data on clinical characteristics, underlying pathology, CSF cytology, antibiotic susceptibilities, and mortality were recorded. To evaluate the outcome following nosocomial postneurosurgical Acinetobacter meningitis/ventriculitis, patients were followed up until discharge or death in the hospital. Kaplan-Meier survival analysis and multivariable Cox proportional hazards models were used to compute factors affecting survival.RESULTSThe study population was divided into two groups depending on the final outcome of whether the patient died or survived. Forty-three patients (59.7%) were included in the survivor group and 29 patients (40.3%) were included in the nonsurvivor group. Total in-hospital mortality due to Acinetobacter meningitis/ventriculitis was 40.3% (29 cases), with a 14-day mortality of 15.3% and a 30-day mortality of 25%. The 43 (59.7%) patients who survived had a mean length of hospital stay of 44 ± 4 days with a median Glasgow Outcome Scale–Extended score at discharge of 6. On univariate analysis, age > 40 years (p = 0.078), admission Glasgow Coma Scale (GCS) score ≤ 8 (p = 0.003), presence of septic shock (p = 0.011), presence of external ventricular drain (EVD) (p = 0.03), CSF white blood cell (WBC) count > 200 cells/mm3 (p = 0.084), and comorbidities (diabetes, p = 0.036; hypertension, p = 0.01) were associated with poor outcome. Carbapenem resistance was not a risk factor for mortality. According to a multivariable Cox proportional hazards model, age cutoff of 40 years (p = 0.016, HR 3.21), GCS score cutoff of 8 (p = 0.006, HR 0.29), CSF WBC count > 200 cells/mm3 (p = 0.01, HR 2.76), presence of EVD (p = 0.001, HR 5.42), and comorbidities (p = 0.017, HR 2.8) were found to be significant risk factors for mortality.CONCLUSIONSThis study is the largest case series reported to date of postneurosurgical Acinetobacter meningitis/ventriculitis. In-hospital mortality due to Acinetobacter meningitis/ventriculitis was high. Age older than 40 years, GCS score less than 8, presence of EVD, raised CSF WBC count, and presence of comorbidities were risk factors for mortality.

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Section: Discussionmentioning

confidence: 99%

Outcome following postneurosurgical Acinetobacter meningitis: an institutional experience of 72 cases

Sharma¹,

Goda²,

Borkar³

et al. 2019

Neurosurgical Focus

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“…We identified 22 studies, 16 of which were observational studies [44–59], five were randomized clinical trials [60–64], and one was systematic review and meta-analysis [65] (Table 2). The studies were based on populations with different sites of infection (airways, bloodstream, abdomen, skin, and meninges) and study population size varying from 10 to 250 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Durante-Mangoni et al found that microbiological success was more likely with colistin-rifampicin combination therapy than colistin monotherapy [64]. Systemic colistin and combinations with localized colistin have been shown to have similar effects on mortality [59].…”

Section: Resultsmentioning

confidence: 99%

Choice of therapeutic interventions and outcomes for the treatment of infections caused by multidrug-resistant gram-negative pathogens: a systematic review

Nørgaard

Jensen

Aalestrup

et al. 2019

Antimicrob Resist Infect Control

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BackgroundAntimicrobial resistance is an increasingly serious threat to public health, and the increased occurrence of multidrug-resistant (MDR) bacteria is a concern in both high-income and low- and middle-income countries. The purpose of this systematic review was to identify and critically appraise current antimicrobial treatment options for infections with MDR Gram-negative bacteria.MethodsA literature search for treatment of MDR extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, A. baumannii, and P. aeruginosa was conducted in MEDLINE in January 2019. Relevant studies published in English, German, and French that evaluated clinical success, microbiological success, and 30-day mortality outcomes were included. The population of interest was adult patients.ResultsOf 672 studies, 43 met the inclusion criteria. Carbapenems are the most common antibiotics used for the treatment of ESBL-producing Enterobacteriaceae. The clinical and microbiological success was similar for group 1 carbapenems (imipenem, meropenem, or doripenem), group 2 carbapenems (ertapenem), and non-carbapenem antibiotics. Mortality data were contradictory for group 1 carbapenems compared to group 2 carbapenems. The most common treatment option for A. baumannii and P. aeruginosa infections was intravenous colistin, regardless of infection site. Clinical success and mortality were similar in A. baumannii infections treated with colistin combination therapy vs. colistin monotherapy, whereas heterogeneous results were found with respect to microbiological success. Monotherapy and colistin combination therapy were used against P. aeruginosa with clinical and microbiological success (70–100%) depending on the infection site and severity, and the antibiotic used. Ceftazidime-avibactam therapy for ESBL-producing Enterobacteriaceae and P. aeruginosa showed good clinical success in one study.ConclusionWe did not find robust evidence for antibiotic treatment of any infection with MDR Gram-negative bacteria, including ESBL-producing Enterobacteriaceae, A. baumannii, and P. aeruginosa, that would lead to a firm recommendation for one specific antibiotic over another or for monotherapy over combination therapy. The choice of antibiotic treatment should be based on susceptibility testing balancing the expected clinical success rate against the risk of development of antibiotic resistance and the risk of severe side effects.

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“…Cases of difficult-to-treat healthcare-associated A. baumannii ventriculitis and meningitis are being reported more frequently [ 4 ]. However, in most of these cases, a combination of IV and IVT/intrathecal colistin achieves good therapeutic outcome [ 5 , 6 ]. Treatment of healthcare-associated A. baumannii ventriculitis and meningitis can be complicated by the development of antimicrobial resistance (especially for meropenem and colistin) [ 7 , 8 ], the development of side effects such as neurotoxicity secondary to colistin [ 7 ], or by failure of antibiotic therapy despite in vitro sensitivity (probably because of insufficient penetration of antibiotics into ventricles and meninges) [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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

Abdallah

Alsaleh

Baradwan

et al. 2020

SN Compr. Clin. Med.

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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.

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Outcomes of adjunctive therapy with intrathecal or intraventricular administration of colistin for post-neurosurgical meningitis and ventriculitis due to carbapenem-resistant acinetobacter baumannii

Cited by 37 publications

References 19 publications

Outcome following postneurosurgical Acinetobacter meningitis: an institutional experience of 72 cases

Outcome following postneurosurgical Acinetobacter meningitis: an institutional experience of 72 cases

Choice of therapeutic interventions and outcomes for the treatment of infections caused by multidrug-resistant gram-negative pathogens: a systematic review

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

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