SummaryAcinetobacter baumannii is a Gram-negative coccobacillus causing serious nosocomial infections. The recent emergence of strains of bacteria, which are resistant to common antibiotics, has made the treatment of these infections increasingly complex. We report the case of a young patient affected by AIDS, who suffered brain toxoplasmosis and sepsis due to multidrug-resistant A baumannii . This bacterial infection was successfully treated with colistin and tigecycline. In addition, we review recent literature on this topic, from the year 2000 to date. showed a left pleural effusion. Epstein-Barr virus and cytomegalovirus infection was ruled out on the basis of a molecular test (PCR).
BMJ Case ReportsBrain CT documented coarse, hypodense and inhomogeneous area, probably due to toxoplasmosis, localised in the left basal ganglia. Other hypodense areas of variable size were diffused bilaterally in all brain parenchyma. Electroencephalogram showed diffuse depressed brain activity, without epileptiform abnormalities.After the onset of suprapubic pain, an abdominal ultrasound scan was performed, which visualised fl uid collection (37×34×66 mm) of probable infectious origin above the bladder located in the point of insertion of the ventricular-peritoneal shunt.The most likely cause of the clinical status of the patient was a meningitis secondary to neurosurgery, which was complicated by the contamination of the shunt with consequent formation of a peritoneal abscess and sepsis. Indeed, ventriculo-peritoneal catheter culture, cerebrospinal fl uid (CSF) examination and peritoneal swab culture revealed the presence of multidrug-resistant (MDR) A baumannii . The bacteria were identifi ed by morphology, Gram stain and reactions with automated instrument Vitek 2 (BioMerieux, Inc.100 Rodolphe Street, Durham, NC 27712).Full in vitro antibiotic susceptibility was exclusively present for colistin (minimum inhibitor concentration (MIC) 1.5 mg/l) and tigecycline (MIC 0.5 mg/l) with a partial susceptibility to amikacin, tobramycin and levofl oxacin.
TREATMENTAt the beginning, antibiotic treatment with meropenem and piperacillin/tazobactam was started.Successively, vancomycin was added to the treatment, following the discovery of the fl uid collection above the bladder.Since culture results detected the presence of MDR A baumannii , the patient was treated with a combined therapy based on the association of colistin (150 000 UI/kg/ day divided in three doses) and tigecycline (3 mg/kg/day divided in two doses) for 4 weeks and then continued with tigecycline alone for another 4 weeks. Therapy was well tolerated. At the same time, highly active antiretroviral therapy treatment led an increase of CD4 cells (126 cells/ ml -5.1%).
OUTCOME AND FOLLOW-UPThe patient's general clinical conditions rapidly improved and there was a reduction of the infl ammation markers, with a complete disappearance of fever after 1 week of therapy. After 2 weeks of therapy, CSF testing gave a negative result. Successive chest x-ray showed gradual improvemen...