Successful Treatment of Multidrug-Resistant Acinetobacter baumannii Meningitis with Intravenous Colistin Sulfomethate Sodium

Me, Jiménez-Mejías; Becerril, Berta; Márquez-Rivas, Javier; Pichardo, C.; Cuberos, L.; Pachón, Jerónimo

doi:10.1007/s100960000400

Cited by 47 publications

(49 citation statements)

References 10 publications

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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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Section: Existing Antimicrobial Agentsmentioning

confidence: 99%

Acinetobacter baumannii : Emergence of a Successful Pathogen

2008

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“…Colistin was not evident in the cerebrospinal fluid (CSF) following systemic administration in children with hydrocephalus (184), and low concentrations were noted in healthy subjects (13). In patients with meningitis, colistin levels in the CSF following intravenous therapy have been reported to reach 1.25 g/ml and to have a half-life of 2.7 h (77,78). Given the fact that these levels are just above the MIC for many nosocomial pathogens, clinicians should have a low threshold for administering intrathecal or intraventricular therapy for patients with meningitis.…”

Section: Distribution and Concentrations In Body Fluidsmentioning

confidence: 99%

“…Numerous case reports demonstrated successful outcomes with intraventricular or intrathecal instillation of colistimethate or polymyxin B in children (12,30,39,50,70,128,133,143,164,176,183) and adults (8,11,22,50,57,66,82,117,120,128,141,142,154,163,175,180,183) with or without corresponding intravenous therapy (Table 7). Given the fact that peak CSF levels of colistin approximate the MIC for most multidrug-resistant P. aeruginosa and A. baumannii strains (77,78), clinicians should have a low threshold for the administration of intrathecal or intraventricular therapy, especially if prompt improvement does not occur with intravenous therapy.…”

Section: Clinical and Microbiological Outcomesmentioning

confidence: 99%

Polymyxins Revisited

et al. 2008

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SUMMARY The global emergence of multidrug-resistant gram-negative bacilli has spurred a renewed interest in polymyxins. Once discarded due to concerns regarding nephrotoxicity and neurotoxicity, polymyxins now hold an important role in the antibiotic armamentarium. However, more reliable information is needed to determine the optimal dosing of these agents. Also, unanswered questions regarding in vitro testing remain, including questions regarding the reliability of automated systems and the establishment of appropriate breakpoints for defining susceptibility. Most contemporary clinical studies examining the use of these agents have involved patients with infections due to multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii strains. It has been reassuring that polymyxin therapy for resistant bacteria has resulted in clinical responses and toxicity rates similar to those for carbapenem therapy for susceptible isolates. While most surveillance studies demonstrated high rates of susceptibility, several reports noted the emergence of polymyxin-resistant nosocomial pathogens. Polymyxins have assumed an important antibiotic niche for therapy for hospital-acquired infections; further studies defining the optimal use of these agents will likely extend the duration of their clinical usefulness.

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“…Currently, only colistin shows in vitro activity against the majority of A. baumannii strains in our hospital (MIC, 0.5 g/ml) and according to some reports of other authors (7,17,28,38). Although we achieved good results using local intrathecal colistin for treatment of catheter-associated ventriculitis (13) and successful intravenous therapy has also been reported in a case of meningitis (20) and in a variety of nosocomial infections (27), clinical experience with colistin is still limited (6,11), and relatively little is known of its efficacy in treating severe infections, especially in comparison with other antibiotics. Furthermore, very few experimental studies using colistin in animal models in protection tests using Pseudomonas aeruginosa have been published (9,35).…”

mentioning

confidence: 92%

Efficacy of Colistin versus β-Lactams, Aminoglycosides, and Rifampin as Monotherapy in a Mouse Model of Pneumonia Caused by Multiresistant Acinetobacter baumannii

Montero¹,

Ariza²,

Corbella³

et al. 2002

Antimicrob Agents Chemother

139

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The treatment of life-threatening infections due to carbapenem-resistant Acinetobacter baumannii has become a serious challenge for physicians worldwide. Often, only colistin shows in general good in vitro activity against these carbapenem-resistant strains, but its antibacterial efficacy in comparison with the antibiotics most used in clinical practice is not well known. We studied the efficacy of colistin versus those of imipenem, sulbactam, tobramycin, and rifampin in an experimental pneumonia model with immunocompetent mice. We used three strains of A. baumannii corresponding to the main clones (A, D, and E) involved in the outbreaks of our hospital, with different grades of resistance to imipenem (imipenem MICs of 1, 8, and 512 g/ml, respectively) and to the other antibiotics. The MIC of colistin was 0.5 g/ml for the three strains. Reduction of log 10 CFU/g in lung bacterial counts, clearance of bacteremia, and survival versus results with controls were used as parameters of efficacy. Imipenem and sulbactam (⌬lung counts: ؊5.38 and ؊4.64 log 10 CFU/ml) showed the highest level of bactericidal efficacy in infections by susceptible and even intermediate strains. Tobramycin and rifampin (؊4.16 and ؊5.15 log 10 CFU/ml) provided good results against intermediate or moderately resistant strains, in agreement with killing curves and pharmacodynamics. On the contrary, colistin showed the weakest antibacterial effect among the antibiotics tested, both in killing curves and in the in vivo model (؊2.39 log 10 CFU/ml; P < 0.05). We conclude that colistin did not appear as a good option for treatment of patients with pneumonia due to carbapenem-resistant A. baumannii strains. Other alternatives, including combinations with rifampin, may offer better therapeutic profiles and thus should be studied.

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Successful Treatment of Multidrug-Resistant Acinetobacter baumannii Meningitis with Intravenous Colistin Sulfomethate Sodium

Cited by 47 publications

References 10 publications

Acinetobacter baumannii : Emergence of a Successful Pathogen

Acinetobacter baumannii : Emergence of a Successful Pathogen

Polymyxins Revisited

Efficacy of Colistin versus β-Lactams, Aminoglycosides, and Rifampin as Monotherapy in a Mouse Model of Pneumonia Caused by Multiresistant Acinetobacter baumannii

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