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 |
  • 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


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.


Bacterial Infection

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Submitted: 2015-06-19 13:23:41
Published: 2015-10-11 00:00:00
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