Intrathecal colistin for drug-resistant Acinetobacter baumannii central nervous system infection: a case series and systematic review

Clin Microbiol Infect. 2010 Jul;16(7):888-94. doi: 10.1111/j.1469-0691.2009.03019.x. Epub 2009 Aug 17.

Abstract

Treatment limitations exist for drug-resistant Acinetobacter baumannii central nervous system (CNS) infection. We conducted a retrospective study and systematic literature review to identify patients with drug-resistant A. baumannii CNS infection who received primary or adjunct intrathecal or intraventricular (IT/IVT) colistin. In a case series of seven Thai patients and 17 patients identified in the literature, clinical and microbiological cure rates with IT/IVT colistin therapy were 83% and 92%, respectively. Three patients (13%) developed chemical ventriculitis and one (4%) experienced treatment-associated seizures. Death was associated with delayed IT/IVT colistin therapy compared to survival (mean time from diagnosis to IT/IVT colistin, 7 vs. 2 days; p 0.01). The only independent predictor of mortality was the severity of illness (APACHE II score > 19, adjusted odds ratio 49.5; 95% CI 1.7-1428.6; p 0.02). This case series suggests that administration of primary or adjunctive IT/IVT colistin therapy was effective for drug-resistant A. baumannii CNS infection.

Publication types

  • Case Reports
  • Review
  • Systematic Review

MeSH terms

  • APACHE
  • Acinetobacter Infections / drug therapy*
  • Acinetobacter Infections / microbiology
  • Acinetobacter baumannii / drug effects*
  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Central Nervous System Bacterial Infections / drug therapy*
  • Central Nervous System Bacterial Infections / microbiology
  • Central Nervous System Infections / drug therapy*
  • Child
  • Child, Preschool
  • Colistin / administration & dosage*
  • Colistin / adverse effects
  • Colistin / pharmacology
  • Colistin / therapeutic use
  • Cross Infection / drug therapy
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • Drug Resistance, Multiple, Bacterial
  • Female
  • Humans
  • Injections, Intraventricular
  • Injections, Spinal
  • Male
  • Middle Aged
  • Risk Factors
  • Thailand
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Colistin