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

Abstract

Background: Due to the blood–brain barrier and limited antibiotic choices, polymyxin is currently the first-line agent for the treatment of central nervous system infections (CNSIs) caused by multidrug-resistant Gram-negative bacteria (MDR-GNB). Colistin sulfate, as a polymyxin E different from CMS, is used in Chinese clinics, and there are limited reports on its use in the treatment of CNSIs. Case Presentation: This case describes a 76-year-old man who underwent complex neurosurgery for cervical spinal stenosis. Postoperatively, the patient developed a fever and a poorly healed surgical wound. Numerous blood routine tests, inflammatory markers, pathogenic tests of cervical secretions, cerebrospinal fluid (CSF), and sputum were sent for diagnosis. After empirical antimicrobial treatments failed, the CSF and wound pus cultured carbapenem-resistant Klebsiella pneumoniae. The regimen was adjusted to colistin sulfate intravenously and intrathecal injection combined with tigecycline. In addition, the management of infection foci, including continuous lumbar pool drain, cervical 3–5 internal fixation removal with cervical 1–6 spine dilation, CSF leak repair, and right thigh broad fasciotomy, were performed. After treatment, the patient was discharged with multiple sets of negative CSF cultures and the infection under control. Conclusions: For CNSIs caused by MDR-GNB, the selection of colistin sulfate for intravenous and topical combination treatment is a viable choice.

Treatment of Central Nervous System Infection Caused by Multidrug-Resistant Acinetobacter baumannii with Intravenous and Intraventricular Colistin Sulfate: A Case Report and Literature Review

“…The treatment duration of IVT and ITH colistin sulfate varied from study to study, while guidelines recommended a duration of 10-21 days for ITH and IVT polymyxin B. 16,17,29 A mean treatment duration of 18 days for polymyxin B administered through the IVT or ITH route is recommended by the international consensus guidelines for the optimal use of the polymyxins. 30 The optimal treatment duration of IVT colistin sulfate is still unclear, and more clinical studies are required.…”

“…Lu et al reported that a patient with CNS infection caused by multidrug-resistant (MDR) Klebsiella pneumoniae was given 50,000 U ITH colistin sulfate and achieved good clinical efficacy. 17 The authors concluded that when administrated at a dose recommended by the international consensus guidelines for optimal use of polymyxins, polymyxin B and colistin sulfate have similar pharmacokinetic characteristics. 28 Unfortunately, the authors did not monitor the CSF concentration of colistin sulfate.…”