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

Abstract

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...

Acinetobacter species meningitis in children: a case series from Karachi, Pakistan

“…At present, resistance to polymyxin is rare and none was observed in our study cohort [22,23]. Pediatric use of polymyxin has recently been reported particularly in post neurosurgical procedure meningitis [8,24]; however, long-term outcomes have not been established.…”

Intraventricular versus intravenous colistin for the treatment of extensively drug resistant Acinetobacter baumannii meningitis

“…The presence of colistin-only susceptible strains and the poor penetration of most antibiotics through the bloodÀbrain barrier have therefore led to the administration of intraventricular (IVT) colistin [3,5,6]. To date, reports on the safety and efficacy of IVT colistin for the treatment of ventriculomeningitis in adults are limited: about 80 cases of Acinetobacter meningitis/ventriculitis treated with intrathecal/intraventricular colistin have been reported, which is mainly due to the low incidence of this condition [5,[7][8][9][10][11][12][13][14][15][16][17][18][19]. In fact, there have been only case reports/ brief series and reviews of patients undergoing IVT colistin for central nervous system (CNS) infection and no comparative studies have been published.…”

Multidrug-resistant Acinetobacter baumannii infection in children

“…Acinetobacter baumannii is a Gram-negative coccobacillus, which is widespread in nature and has emerged as an important nosocomial pathogen in recent years, especially in intensive care units (ICUs) 1. The incidence of A baumannii infections has increased during the past decades, probably because of a rise in the proportion of the population susceptible to infections, as a result of advancement in the treatment of critically ill patients.…”