Management of meningitis caused by multi drug-resistant Acinetobacter baumannii: clinical, microbiological and pharmacokinetic results in a patient treated with colistin methanesulfonate

Elisabetta Schiaroli, Maria Bruna Pasticci, Maria Iris Cassetta, Stefania Fallani, Corrado Castrioto, Matteo Pirro, Andrea Novelli, Lucia Henrici De Angelis, Marco Maria D'Andrea, Maria Lina Mezzatesta, Franco Baldelli, Antonella Mencacci
  • Elisabetta Schiaroli
    Unit of Infectious Diseases, Department of Medicine, University of Perugia, Perugia, Italy, Italy | elisabettask@libero.it
  • Maria Bruna Pasticci
    Affiliation not present
  • Maria Iris Cassetta
    Affiliation not present
  • Stefania Fallani
    Affiliation not present
  • Corrado Castrioto
    Affiliation not present
  • Matteo Pirro
    Affiliation not present
  • Andrea Novelli
    Affiliation not present
  • Lucia Henrici De Angelis
    Affiliation not present
  • Marco Maria D'Andrea
    Affiliation not present
  • Maria Lina Mezzatesta
    Affiliation not present
  • Franco Baldelli
    Affiliation not present
  • Antonella Mencacci
    Affiliation not present

Abstract

This paper reports on a 71-year-old Caucasian male who underwent  neurosurgery for an oligodendroglioma, followed by a cranial-sinus fistula and cerebrospinal fluid rhinorrhea. The clinical course was complicated due to an extensively drug-resistant Acinetobacter baumannii meningitis. The patient was treated with colistin methanesulfonate, intrathecal for 24 days and intravenous for 46 days. In addition, the patient received meropenem and teicoplanin to treat a bacterial aspiration pneumonia, probably caused by methicillin resistant Staphylococcus aureus and multi drug-resistant Klebiesella pneumoniae. Cerebrospinal fluid trough colistin levels resulted above the MIC of A. baumannii. Colistin cerebrospinal fluid accumulation over the treatment period was not reported.  Meningitis was cured and A. baumannii eradicated. No side effects  from the antimicrobial therapy were observed.

In conclusion, this case highlights the issues in treating infections caused by resistant Gram-negative bacteria and supports previous findings on the efficacy, pharmacokinetic and tolerability of intravenous and  intrathecal colistin treatments.

Keywords

Bacterial Infection

Full Text:

PDF
HTML
Submitted: 2015-06-19 13:23:41
Published: 2015-10-11 00:00:00
Search for citations in Google Scholar
Related articles: Google Scholar

References

Wang KW, Chang WN, Huang CR, Tsai NW, Tsui HW, Wang HC, Su TM, Rau CS, Cheng BC, Chang CS, Chuang YC, Liliang PC, Tsai YD, Lu CH. Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes. J Clin Neurosci 2005;12:647-650.

Kim B-N, Peleg AY, Lodise TP, Lipman J, Nation R, Paterson DL. Management of meningitis due to antibiotic-resistant Acinetobacter species. Lancet 2009;9:245-255.

Karaiskos I, Galani L, Bazika F, Katsouda E, Ioannidis I, Andreou A, Paskalis H, Giamarellou H. Successful treatment of extensively drug-resistant Acinetobacter baumannii ventricultitis and meningitis with intraventricular colistin after application of a loading dose: a cases series. Intern J Antimicrob Agent 2013;4:480-483.

Hara GH, Gould I, Endimiani A, Pardo PR, Daikos G, Hsueh PR, Mehtar S, Petrikko G, Casellas JM, Daciuk L, Paciel D, Novelli A, Saginur R, Pryluka D, Medina J, Savio E. Detection, treatment, and prevention of carbapenemase-producing Enterobacteriaceae: recommendations from an International Working Group. J Chemother 2013; 25:129-140.

Daikos GL, Tsaousi S, Tzouvelekis LS, Anyfantis I, Psichogiou M, Agrypoulou A, Stefanou I, Sypsa V, Miriagou V, Nepka M, Georgiadou S, Markogiannakis A, Goukos D, Skoutelis A. C. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother 2014;58:2322-2328.

Imberti R, Cusato M, Accetta G, Marinò V, Procaccio F, Del Gaudio A, Iotti GA, Regazzi M. Pharmacokinetics of colistin in cerebrospinal fluid after intraventricular administartion of colistin methanesulfonate. Antimicrob Agent Chemother 2012;56: 4416-4421.

Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-332.

Mencacci A, Leli C, Cardaccia A, Montagna P, Moretti A, Bietolini C, Meucci M, Perito S, Cenci E, Bistoni F. Comparison of conventional culture with SeptiFast real-time PCR for microbial pathogen detection in clinical specimens other than blood. J Med Microbiol 2011;60:1774-1778.

Wang MC, Lin WH, Yan JJ, Fang HY, Kuo TH, Tseng CC, Wu JJ. Early identification of microorganisms in blood culture prior to the detection of a positive signal in the BACTEC FX system using matrix-assisted laser desorption/ionization–time of flight mass spectrometry. J Microbiol Immunol Infect 2013; doi:10.1016/j.jmii.2013.10.006.

Van de Beek D, Drake JM, Tunkel AR. Nosocomial bacterial meningitis. N Engl J Med 2011;362:146-154.

Li J, Milne RW, Nation RL, Turnidge JD, Coulthard K, Johnson DW. A simple method for the assay of colistin in human plasma, using pre-column derivation with 9-fluorenylmethyl chloroformate in solid-phase extraction cartridges and reversed-phase high-performance liquid chromatography. Chromatogr B Biomed Sci Appl. 2001;761:167-175.

Chang S-S, Hsieh W-H, Liu T-S, Lee SH, Wang CH, Chou HC, Yeo YH, Tseng CP, Lee CC. Multiplex PCR system for rapid detection of pathogens in patients with presumed sepsis-a systematic review and meta-analysis. PLos ONE 2013;8:e62323-62333.

Abstract views:
232

Views:
PDF
145
HTML
518

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM


Copyright (c) 2016 Mediterranean Journal of Hematology and Infectious Diseases

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

 

The Mediterranean Journal of Hematology and Infectious Diseases [eISSN 2035-3006] is owned by the U.C.S.C. and it is published by PAGEPress®, Pavia, Italy. All credits and honors to PKP for their OJS.
 
 
© PAGEPress 2008-2017     -     PAGEPress is a registered trademark property of PAGEPress srl, Italy.     -     VAT: IT02125780185