Successful Treatment With Intrathecal and Intravenous Polymyxin B-Based Combination Against MDR Acinetobacter baumannii Meningitis in Pediatric Patient: A Case Report

Abstract

Background: Nosocomial meningitis with multidrug-resistant (MDR) or extensively drug-resistant (XDR) Acinetobacter baumannii is a life-threatening complication in neurosurgery. Treatment of these infections is challenging because of poor penetration of the available antibiotics into the cerebrospinal fluid (CSF). Intrathecal (ITH) or intraventricular (IVT) administration of antibiotics is increasingly used as the last treatment option against MDR/XDR Gram-negative bacteria meningitis not responding to intravenous (IV) regimens. However, pertinent data in pediatric patients is scarce.Case Presentation: A 14-year-old male patient developed meningitis from an MDR strain of A. baumannii following endoscopic endonasal resection of craniopharyngioma. Despite a combination therapy involving IV tigecycline, we observed clinical and bacteriologic failure. The patient was then successfully treated with an ITH and IV polymyxin B-based combination. Quantification of tigecycline and polymyxin B in CSF was performed with two-dimensional high-performance liquid chromatography (2D-HPLC) and HDLC coupled with tandem mass spectrometry (HPLC-MS/MS), respectively. Adverse drug reactions (neurotoxicity and skin hyperpigmentation), probably induced by polymyxin B, were acceptable and reversible.Conclusions: The case illustrates ITH and IV Polymyxin B-based combination is an optimal therapeutic option against MDR A. baumannii meningitis in this pediatric patient. In the future, real-time PK/PD data obtained from patients during ITH/IVT polymyxin B therapy should be required to optimize polymyxin use with maximal efficacy and minimal adverse effects.

Intrathecal Injection of Tigecycline and Polymyxin B in the Treatment of Extensively Drug-Resistant Intracranial Acinetobacter baumannii Infection: A Case Report and Review of the Literature

“… 34 Therefore, it can be seen that polymyxin B is relatively safe. In addition, there are other small sample studies that have confirmed the same efficacy of polymyxin B 35–40 ( Table 3 ). In most cases, craniocerebral trauma and cerebral hemorrhage are common primary diseases.…”

Intrathecal Injection of Polymyxin B in a Child with Meningitis Caused by Carbapenem-Resistant Pseudomonas aeruginosa: A Case Report and Literature Review

“…The neonate received intraventricular polymyxin B at 40,000 units per dose for 14 doses. 16 Xing H 18 selected 50,000 U once per day for the first 4 days, then 50,000 U once every other day. Another boy in early childhood received 5mg once per day.…”

Treatment of Central Nervous System Infection Caused by Multidrug-Resistant Klebsiella pneumoniae with Colistin Sulfate Intravenously and Intrathecally: A Case Report

“…Common adverse effects include nephrotoxicity, neurotoxicity, and pigmentation of the skin (polymyxin B sulfate only). Several studies have shown the efficacy of intravenous infusions of CMS or PBS and intraventricular/intrathecal injections in the treatment of NCNSIs [4][5][6]. CS (from Shanghai New Asia Pharmaceuticals, Shanghai, China) was approved for clinical use by the Chinese National Medical Products Administration on 16 April 2018 [7], and has rarely been reported in its clinical application.…”