Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments

Guardado, Azucena Rodríguez; Blanco, Armando; Asensi, Vı́ctor; Perez, Francisco A.; Burguillo, Juan C.; Pintado, Vicente; Bustillo, Eduardo; Lantero, M; Tenza, E; Álvarez, María E.; Maradona, José A.; Cartón, José A.

doi:10.1093/jac/dkn018

Cited by 109 publications

(68 citation statements)

References 29 publications

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“…6,7 A. baumannii infection is common in patients with severe infections, and is often accompanied by other bacterial and/or fungal infections. 8 Patients infected with resistant A. baumannii have high mortality. 9 Therefore, there is an urgent need to find suitable therapeutic drugs for the treatment of resistant A. baumannii infections.…”

Section: Introductionmentioning

confidence: 99%

Effects of silver nanoparticles in combination with antibiotics on the resistant bacteria <em>Acinetobacter baumannii</em>

Wan

Ruan

et al. 2016

IJN

123

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Acinetobacter baumannii resistance to carbapenem antibiotics is a serious clinical challenge. As a newly developed technology, silver nanoparticles (AgNPs) show some excellent characteristics compared to older treatments, and are a candidate for combating A. baumannii infection. However, its mechanism of action remains unclear. In this study, we combined AgNPs with antibiotics to treat carbapenem-resistant A. baumannii (aba1604). Our results showed that single AgNPs completely inhibited A. baumannii growth at 2.5 μg/mL. AgNP treatment also showed synergistic effects with the antibiotics polymixin B and rifampicin, and an additive effect with tigecyline. In vivo, we found that AgNPs–antibiotic combinations led to better survival ratios in A. baumannii -infected mouse peritonitis models than that by single drug treatment. Finally, we employed different antisense RNA-targeted Escherichia coli strains to elucidate the synergistic mechanism involved in bacterial responses to AgNPs and antibiotics.

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Section: Introductionmentioning

confidence: 99%

Effects of silver nanoparticles in combination with antibiotics on the resistant bacteria <em>Acinetobacter baumannii</em>

Wan

Ruan

et al. 2016

IJN

123

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“…Acinetobacter meningitis is usually seen in the neurosurgical setting associated with craniotomies, ventriculostomy tubes, and head injuries. Previous studies showed that A. baumannii was responsible for 4.5% of meningitis in post-surgical patients and 10.9% in those with intraventricular catheters [3,4]. Of our patients two had a placement of a ventriculostomy catheter and the third had a craniotomy for medulloblastoma.…”

mentioning

confidence: 68%

“…The clinical manifestations of A. baumannii post-surgical meningitis are unremarkable, mostly fever and progressive loss of consciousness [3]. From this point of view examination of CSF should be performed in all patients with suspected shunt infection.…”

mentioning

confidence: 99%

Successful treatment of three children with post-neurosurgical multidrug-resistant Acinetobacter baumannii meningitis

et al. 2010

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In this report we present the clinical features and the treatment of three children with multidrug-resistant (MDR) Acinetobacter baumannii meningitis. All three patients were referred to the Department of Pediatrics from the Department of Neurosurgery, Ankara University Medical Faculty. The clinical, laboratory and treatment characteristics of these patients are summarized in Table 1. For all patients, MDR A. baumannii meningitis was diagnosed with cerebrospinal fluid (CSF) culture isolates susceptible to colistin and resistant to other antibiotics including aminoglycosides, carbapenems, ciprofloxacin, sulbactam and piperacillin-tazobactam.Case 1: A 3-year-old girl with choroid plexus papilloma underwent surgery for the placement of a ventriculostomy catheter. Ceftriaxone was administered during surgery for prophylaxis. She had a fever (39°C) on day 7 of surgery and CSF examination showed white blood cells of 400/mm 3 , red blood cells of 10/mm 3 , protein of 60 mg/dL and glucose of 12 mg/dL and microscopic examination revealed gram-negative coccobacilli. With these results, diagnosis of meningitis was made and the patient was started on meropenem (120 mg/kg/day divided q8h) intravenously. The ventriculostomy catheter was also replaced. With the report of MDR A. baumannii grew from the CSF cultures on the second day of treatment, intravenous ampicillin-sulbactam (400 mg/kg/day divided q6h), intravenous amikacin (22.5 mg/kg/day divided q12h) and peroral rifampin (20 mg/kg/day) were added to the antibiotic regimen. CSF cultures taken on day 5 and 10 of the combination treatment remained positive for MDR A. baumannii and the antibiotic susceptibilies of these following cultures were the same as the first isolate. Intravenous colistin (50,000 IU/kg/day divided q8h) and intrathecal colistin (125,000 IU/d) was initiated on day 5 of the treatment. On day 14 meropenem, amikacin and rifampin were stopped and ampicillin-sulbactam and colistin were continued for 45 days without any serious side effects. After the sterilization of CSF (5 days after the initiation of colistin therapy) a ventriculoperitoneal shunt (VPS) was placed instead of ventriculostomy catheter.Case 2: A 14-year-old girl with medulloblastoma had a fever (39.3°C) on day 3 following intracranial surgery. She also received ceftriaxone for prophylaxis during surgery. The CSF examination showed white blood cells of 120/mm 3 , red blood cells of 10/mm 3 , protein of 114 mg/dL and glucose of 14 mg/dL. With the diagnosis of meningitis, intravenous meropenem (120 mg/kg/day divided q8h) and intravenous vancomycin (60 mg/kg/day divided q6h) were initiated. On the third day of treatment, after the confirmation of the presence of MDR A. baumannii in CSF cultures, vancomycin was changed to intravenous ampicillin-sulbactam (400 mg/kg/day divided q6h) and peroral rifampin (20 mg/kg/day) was added. The CSF became sterile 4 days after the initiation of ampicillin-sulbactam and rifampin. The patient was cured after a 4-week course of meropenem, ampicillin-sulbactam and rifa...

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“…The commonly used empiric antimicrobial agents for treatment of Acinetobacter meningitis is a carbapenem (ie, meropenem) given intravenously with or without gentamicin or amikacin given either by the intraventricular or intrathecal route [27•]. If the organism is resistant to carbapenems, colistin (usually formulated as colistimethate sodium) or polymyxin B should be given intravenously, and may also need to be administered by either the intrathecal or intraventricular route [28]; the colistin dose in patients with intact renal function is usually 10 mg once daily or 5 mg every 12 h, although in one study, patients received 10 mg every 12 h without an increase in adverse effects [29]. In this retrospective study of 51 patients with Acinetobacter meningitis, all eight patients treated with the combination of intravenous and intrathecal colistin survived [29].…”

Section: Antimicrobial Therapymentioning

confidence: 99%

Healthcare-Associated Bacterial Meningitis

Laxmi

Tunkel

2011

Curr Infect Dis Rep

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Healthcare-associated bacterial meningitis may occur after neurosurgical procedures, head trauma, and following placement of external or internal ventricular catheters. The likely microorganisms that cause meningitis in this setting (ie, staphylococci and gram-negative bacilli) are different from those that cause meningitis in the community setting. Any clinical suspicion of healthcare-associated bacterial meningitis should prompt a diagnostic evaluation (neuroimaging and cerebrospinal fluid analysis) and appropriate management. Empiric antimicrobial therapy should be directed toward the likely infecting pathogen; based upon clinical response, intraventricular administration of specific agents may be required. With the emergence of resistant gram-negative bacilli (especially Acinetobacter baumannii) that may cause healthcare-associated meningitis, empiric therapy with a carbapenem, with or without an aminoglycoside administered by the intraventricular or intrathecal route, is recommended; colistin (given intravenously and/or intraventricularly) can be used if the organism is subsequently found to be resistant to carbapenems.

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Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments

Abstract: 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.

Cited by 109 publications

References 29 publications

Effects of silver nanoparticles in combination with antibiotics on the resistant bacteria <em>Acinetobacter baumannii</em>

Effects of silver nanoparticles in combination with antibiotics on the resistant bacteria <em>Acinetobacter baumannii</em>

Successful treatment of three children with post-neurosurgical multidrug-resistant Acinetobacter baumannii meningitis

Healthcare-Associated Bacterial Meningitis

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