JAC Advance Access published online on February 15, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn018
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Original research |
Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments
1 Infectious Diseases Unit, Hospital Central de Asturias, Spain 2 Intensive Care Unit, Hospital Central de Asturias, Spain 3 Microbiology Unit, Hospital Central de Asturias, Spain 4 Neurosurgery Unit, Hospital Central de Asturias, Spain 5 Infectious Disease Unit, Hospital Ramón y Cajal, Spain 6 Biostatistical Unit, Hospital Central de Asturias, Spain
Received 4 August 2007; returned 4 December 2007; revised 14 November 2007; accepted 20 December 2007
* Corresponding author. Tel: +34-985108000; Fax: +34-985108015; E-mail: azucenarodriguez{at}telecable.es
Background: The treatment of multidrug-resistant Acinetobacter baumannii meningitis is a serious therapeutic problem due to the limited penetration of antibiotics into the CSF. We describe the clinical features and the outcome of a group of patients with nosocomial neurosurgical meningitis treated with different therapeutic options.
Methods: All patients with nosocomial post-surgical meningitis due to A. baumannii diagnosed between 1990 and 2004 were retrospectively reviewed.
Results: During the period of study, 51 cases of this nosocomial infection were identified. Twenty-seven patients were treated with intravenous (iv) monotherapy: carbapenems (21 cases), ampicillin/sulbactam (4 cases) and other antibiotics (2 cases). Four patients were treated with iv combination therapy. Nineteen patients were treated with iv and intrathecal regimens: colistin by both routes (8 cases), carbapenems plus iv and intrathecal (4 cases) or only intrathecal (5 cases) aminoglycosides, and others (2 cases). Seventeen patients died due to the infection. One patient died without treatment. The mean (SD) duration of therapy was 17.4 (8.3) days (range 3–44). Although no patients treated with colistin died, we did not observe statistically significant differences in the mortality among the groups with different treatments.
Conclusions: Nosocomial Acinetobacter meningitis has a high mortality. Combined therapy with iv and intrathecal colistin is a useful and safe option in the treatment of nosocomial Acinetobacter meningitis.
Key Words: nosocomial meningitis , Acinetobacter baumannii , colistin treatment , intrathecal colistin , neurosurgery