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JAC Advance Access published online on August 17, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl347
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Received April 11, 2006
Revised July 20, 2006
Accepted August 2, 2006

Breif report

Cure of multiresistant Acinetobacter baumannii central nervous system infections with intraventricular or intrathecal colistin: case series and literature review

John Ng 1, Iain B. Gosbell 2 *, John A. Kelly 1, Michael J. Boyle 3, and John K. Ferguson 3

1 Department of Microbiology and Infectious Diseases, South Western Area Pathology Service, Liverpool, Sydney, New South Wales, Australia
2 Department of Microbiology and Infectious Diseases, South Western Area Pathology Service, Liverpool, Sydney, New South Wales, Australia; Department of Pathology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
3 Clinical Immunology & Infectious Diseases Unit, John Hunter Hospital, New Lambton, Newcastle, New South Wales, Australia

* To whom correspondence should be addressed.
Iain B. Gosbell, E-mail: Iain.Gosbell{at}sswahs.nsw.gov.au


  Abstract

Objectives: CNS infections due to multiresistant Acinetobacter baumannii (MRAB) are an emerging problem in neurosurgical patients. Colistin remains one of the few remaining treatment options for MRAB but has poor CNS penetration. We describe our experience with intraventricular or intrathecal colistin for this infection.

Methods: Cases known to have received intraventricular or intrathecal colistin for CNS infections due to MRAB were retrospectively reviewed regarding colistin treatment, colistin efficacy and adverse events.

Results: Five patients were identified. All were admissions to the neurosurgical ICU and all were cured of their CNS infections. Three cases were complicated by drug-induced aseptic meningitis or ventriculitis.

Conclusions: This largest case series to date shows that direct instillation of colistin into the CNS may cause chemical meningitis or ventriculitis but it is an effective treatment option for MRAB CNS infection. Further study of dosing regimens is needed.

Keywords: A. baumannii; CNS infections; polymyxin E; injections; ventriculitis; meningitis.
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