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Succesful treatment of multidrug-resistant Acinetobacter baumannii meningitis with colistin and rifampicin

Abstract number: 1733_711

Memikoglu K.O., Alver Alkaya F., Köken Z., Serdaroglu H., Çakir T., Azap A.

Introduction: The treatment of multidrug-resistant A. baumannii infections is a serious therapeutic problem, especially in patients with meningitis because antibiotics have a limited ability to penetrate cerebrospinal fluid (CSF). Meningitis due to Acinetobacter spp. has an associated mortality rate of 20–27%. We described here a case of meningitis caused by multidrug-resistant Acinetobacter baumannii, which was suspectible to colistin and treated succesfully with intravenous and intrathecal use of colistin with rifampicin.

Case Report: A 38-year-old male was operated because of schwannoma. On day 9 external CSF shunt was installed. On day 11 the patient presented fever, headache, nause and vomitting and somnolance. Physical examination revealed a severly ill patient with lethargy and meningism. CSF showed pleocytosis (250 cells/ml; with polymorphonuclear neutrophil, dominance (100%), a protein level of 321 mg/dl, and a glucose level of 20 mg/dl (blood glucose level was 105 mg/dl). Meropenem (1 g q8h), vancomycin (1 g q12h) and rifampicin 10 mg/kg q12h po) were began. Multidrug-resistant A. baumannii was isolated from the CSF. Meropenem was stopped and the treatment changed to colistin intravenous (2 g q8h) and intrathecal (50.000U for the first 3 day and 50.000 U on alternative days). On day 2 of treatment the CSF was sterile. Treatment was maintained for 21 days and the patient was discharged.

Discussion: High use rates of broad-spectrum antibiotics in critically ill patients have been corraleted with the emergence of resistance in Acinetobacter strains. In a large serious of adults with acute bacterial meningitis Acinetobacter spp. were found to be responsible for approximately 10% of Gram negative bacillary and 4% of all nosocomial meningitis. Alternative therapies in multidrug-resistant A. baumannii infections such as colistin are being increasingly employed. Intrathecal colistin has been used with good results in case of multidrug-resistant A. baumannii meningitis. Cure seems to be more frequent among patients receiving combination systemic and intrathecal therapy.

Conclusion: Intravenous and intrathecal use of colistin with rifampicin may be a potentially effective therapy in cases of meningitis caused by A. baumannii resistant to carbapenems and other b-lactam agents.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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