Post-Neurosurgical Meningitis Due to Multidrug-Resistant<i>Acinetobacter baumanii</i>Treated with Intrathecal Colistin: Case Report and Review of the Literature

Shirawi, Nehad; Memish, Ziad A.; Cherfan, Antoine; Shimemeri, Abdullah Al

doi:10.1179/joc.2006.18.5.554

Cited by 25 publications

(17 citation statements)

References 38 publications

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“…Meningeal signs, focal neurological signs, and seizure are found in a minority of patients 60. Increased CSF white blood cell counts (ranging from 100 to several thousand cells per μL) are typical,19,21,23,27–32,35,37,44,53,58,60 with higher counts presumably found in those with delays in clinical suspicion of infection. However, cases of true infection that have no CSF white blood cells have been reported 60.…”

Section: Clinical Characteristicsmentioning

confidence: 99%

Management of meningitis due to antibiotic-resistant Acinetobacter species

Kim

Peleg

Lodise

et al. 2009

The Lancet Infectious Diseases

195

149

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Acinetobacter meningitis is becoming an increasingly common clinical entity, especially in the postneurosurgical setting, with mortality from this infection exceeding 15%. Infectious Diseases Society of America guidelines for therapy of postneurosurgical meningitis recommend either ceftazidime or cefepime as empirical coverage against Gram-negative pathogens. However, assessment of the pharmacodynamics of these cephalosporins in cerebrospinal fluid suggests that recommended doses will achieve pharmacodynamic targets against fewer than 10% of contemporary acinetobacter isolates. Thus, these antibiotics are poor options for suspected acinetobacter meningitis. From in vitro and pharmacodynamic perspectives, intravenous meropenem plus intraventricular administration of an aminoglycoside may represent a superior, albeit imperfect, regimen for suspected acinetobacter meningitis. For cases of meningitis due to carbapenem-resistant acinetobacter, use of tigecycline is not recommended on pharmacodynamic grounds. The greatest clinical experience rests with use of polymyxins, although an intravenous polymyxin alone is inadvisable. Combination with an intraventricularly administered antibiotic plus removal of infected neurosurgical hardware appears the therapeutic strategy most likely to succeed in this situation. Unfortunately, limited development of new antibiotics plus the growing threat of multidrug-resistant acinetobacter is likely to increase the problems posed by acinetobacter meningitis in the future.

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Section: Clinical Characteristicsmentioning

confidence: 99%

Management of meningitis due to antibiotic-resistant Acinetobacter species

Kim

Peleg

Lodise

et al. 2009

The Lancet Infectious Diseases

195

149

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“…Several cases of A. baumannii meningitis have been cured with i.v. colistin only (267,269,327,416), with reported levels in CSF of 1.25 mg/liter (CSF/serum ratio of 25%) (267,269); however, failures have also been reported that eventually responded only to intrathecal/ventricular administration (7,67,286,398,526). Dosing varies greatly between studies, but according to the Infectious Diseases Society of America, 5 mg of polymyxin B or 10 mg of colistin daily is recommended for adults (553).…”

Section: Existing Antimicrobial Agentsmentioning

confidence: 99%

Acinetobacter baumannii : Emergence of a Successful Pathogen

2008

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SUMMARY Acinetobacter baumannii has emerged as a highly troublesome pathogen for many institutions globally. As a consequence of its immense ability to acquire or upregulate antibiotic drug resistance determinants, it has justifiably been propelled to the forefront of scientific attention. Apart from its predilection for the seriously ill within intensive care units, A. baumannii has more recently caused a range of infectious syndromes in military personnel injured in the Iraq and Afghanistan conflicts. This review details the significant advances that have been made in our understanding of this remarkable organism over the last 10 years, including current taxonomy and species identification, issues with susceptibility testing, mechanisms of antibiotic resistance, global epidemiology, clinical impact of infection, host-pathogen interactions, and infection control and therapeutic considerations.

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“…baumannii is a successful nosocomial pathogen and is highly prevalent in Saudi intensive care units (ICUs), causing numerous outbreaks, many of them involving multidrug-resistant strains (Mah et al, 2001;Manzar, 2004;Al Shirawi et al, 2006;Bukhary et al, 2005;Yezli et al, 2014). There is evidence that resistance is increasing to many antibiotics in the Kingdom, including to carbapenems, which nevertheless remain the treatment of choice for most A. baumannii infections (Yezli et al, 2014).…”

Section: A Baumanniimentioning

confidence: 99%

The molecular basis of β-lactamase production in Gram-negative bacteria from Saudi Arabia

Yezli

Shibl

Memish

2015

Journal of Medical Microbiology

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Resistance to b-lactams among Gram-negative bacteria is a worldwide issue. Increased prevalence of extended-spectrum b-lactamase (ESBL)-producers and the dissemination of carbapenem-resistance genes are particularly concerning. ESBL-producing strains are common in the Kingdom of Saudi Arabia, particularly among the Enterobacteriaceae, and carbapenem resistance is on the increase, especially among the non-fermenters. b-lactamase production is a major mechanism of resistance to these agents and although b-lactamase-producing strains have been documented in the Kingdom, relatively few reports characterized the molecular basis of this production. Nevertheless, available data suggest that CTX-M (CTX-M-15 in particular) is the predominant ESBL in the Enterobacteriaceae, with SHV also being prevalent in Klebsiella pneumoniae. Carbapenem resistance in the latter is mainly due to OXA-48 and NDM-1. In Pseudomonas aeruginosa, VEB-like enzymes are the most common ESBLs, and VIM is the prevalent metallo-b-lactamase. OXA-10 extended-spectrum enzymes are also frequent. PER and GES ESBLs have been reported in Acinetobacter baumannii, and oxacillinases (OXA-23 in particular) are the dominant carbapanamases in this species. IntroductionInfections due to Gram-negative bacteria are a leading cause of morbidity and mortality worldwide (Giske et al., 2008). Antimicrobial agents are a major therapeutic tool in the treatment of such infections. However, antimicrobial resistance among Gram-negative bacteria, particularly among the Enterobacteriaceae and the non-fermenters, has become one of the most serious public health concerns worldwide (Giske et al., 2008;Livermore, 2012). The global dissemination of resistance has recently received much attention, especially following reports of the international spread of multi-resistant Enterobacteriaceae, particularly strains resistant to cephalosporins due to the production of CTX-M-type extended-spectrum b-lactamases (ESBLs) and strains producing carbapenemases such as KPC and NDM (Nordmann et al., 2011;Johnson & Woodford, 2013). The spread of resistance determinants is facilitated by a number of factors, including presence on genetic mobile elements, antibiotic misuse, poor infection control practices, and increased international travel. In this context Saudi Arabia is particularly relevant as it is annually a host for more than 4 million Muslim pilgrims from over 180 countries worldwide in the Hajj and Umra seasons. In addition, up to 6 million of the Kingdom's population are expatriates, mainly from south and east Asia, where antimicrobial resistance is rife, including to carbapenems (Yong et al., 2009). These factors could potentially make Saudi Arabia a hot spot for the collection of multidrug-resistant strains and the spread of antibiotic resistance around the world.We previously reported on the antimicrobial resistance among the key Gram-negative bacteria in Saudi Arabia and found increased prevalence of b-lactam-resistant strains, including ESBL-producers, and carbapenem resistance (Y...

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Post-Neurosurgical Meningitis Due to Multidrug-ResistantAcinetobacter baumaniiTreated with Intrathecal Colistin: Case Report and Review of the Literature

Cited by 25 publications

References 38 publications

Management of meningitis due to antibiotic-resistant Acinetobacter species

Management of meningitis due to antibiotic-resistant Acinetobacter species

Acinetobacter baumannii : Emergence of a Successful Pathogen

The molecular basis of β-lactamase production in Gram-negative bacteria from Saudi Arabia

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