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

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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
(*) Corresponding Author:
Elisabetta Schiaroli | elisabettask@libero.it

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.


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