Place of Colistin-Rifampicin Association in the Treatment of Multidrug-ResistantAcinetobacter BaumanniiMeningitis: A Case Study

Abstract

Treatment of Acinetobacter baumannii meningitis is an important challenge due to the accumulation of resistance of this bacteria and low meningeal diffusion of several antimicrobial requiring use of an antimicrobial effective combination to eradicate these species. We report a case of Acinetobacter baumannii multidrug-resistant nosocomial meningitis which was successfully treated with intravenous and intrathecal colistin associated with rifampicin.

International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti‐infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP)

“…A systematic review of the evidence regarding clinical efficacy and safety of IVT or ITH colistin or polymyxin B was conducted . A total of 234 cases of gram‐negative health care–associated ventriculitis or meningitis treated with IVT or ITH colistin or polymyxin B were reported.…”

“…153 A systematic review of the evidence regarding clinical efficacy and safety of IVT or ITH colistin or polymyxin B was conducted. [159][160][161][162][163][164][165][166][167][168][169][170][171][172][173][174][175][176] A total of 234 cases of gram-negative health care-associated ventriculitis or meningitis treated with IVT or ITH colistin or polymyxin B were reported. Intraventricular or ITH colistin was administered in 87% of cases and polymyxin B in the remaining 13%.…”

Review of the international consensus guidelines for the optimal use of the polymyxins

“…Был проведен систематический обзор доказательных данных в отношении клинической эффективности и безопасности ИВТ или ИТК введения колистина [159][160][161][162][163][164][165][166][167][168][169][170][171][172][173][174][175][176]. В общей сложности было включено 234 случая нозокомиального грамотрицательного вентрикулита или менингита, в отношении которых применялось ИВТ или ИТК введение колистина или полимиксина В. Интравентрикулярный или ИТК колистин применялся в 87% случаев, в то время как полимиксин В -в оставшихся 13%.…”

Therapeutic drug monitoring for colistin therapy in severe multi-resistant Acinetobacter intracerebral abscess: A single case study with high-dose colistin and review of literature

“…Results of comprehensive literature search for case reports with colistin as treatment for patients with intracranial infections published expanding the recent reviews. 3,[10][11][12] 170.000 IU (mean ± 400 IU) 9 MIU -Hospital mortality: 3/23 IVT, 8/11 IV De Bonis et al 3 18 (9 IV, 9 IVT) 10-20 mg (0.25-0.5 MIU) -12/18 (9/9 IVT, 3/9 IV) 4/9 IVT, 7/9 IV Shofty et al 5 95, of which 50 were analyzed Median dose 0.05 MIU (range, 0.05-0.25 MIU/day) 22 patients were treated --30-day mortality: 2/23 IVT (1/10 Col-IVT) 9/27 IVT Souhail et al 9 1 0.125 MIU/day 12 MIU -0/1 IV: intraventricular colistin therapy only; IVT: intraventricular + intravenous combination therapy; MIU: million international units.…”

“…Recommendations were given by the Infectious Disease Society of America in 2004 2 including intraventricular antibiotic therapy and this has also been discussed in a comment from the European medicines agency 2014. For infections due to MDR Gram-negative pathogens, the intraventricular administration of colistin was successfully used in a wide range of case studies, 3 – 9 exemplarily reported by Karaiskos et al, 8 by Souhail et al in combination with rifampicin, and by Dalgic et al 7 in a girl of 2 months. Evidence for colistin therapy is also summarized in reviews 3 , 10 – 12 reporting an overall clinical response rate of about 90%.…”