S Sahin, A Selik, D Memis
cns infections, colistin, infection, meningitis, nosocomial
S Sahin, A Selik, D Memis. Intrathecal Colistin For Treatment Of Acinetobacter Spp Meningitis: Case Report. The Internet Journal of Infectious Diseases. 2007 Volume 6 Number 2.
We report a case of meningitis caused by a multiresistant gram-negative rod that was successfully treated with intrathecal colistin.
A 30-year-old boy who had a car accident required hospitalization, including decompressive craniectomy and placement of an external ventricular drainage catheter. Cerebrospinal fluid and blood cultures demonstrated
Our experience shows that intrathecal colistin is a safe and curative treatment drug for multidrug-resistant
In a large series of adults with acute bacterial meningitis Acinetobacter spp. were found to be responsible for approx. 10% of Gram negative bacillary and 4% of all nosocomial meningitides(1) Treatment of meningitis due to multi-drug resistant
A 30-year-old boy who had a car accident required hospitalization, including decompressive craniectomy and placement of an external ventricular drainage catheter. The patient was not on any medication, had no history of alcohol abuse and had an unremarkable medical record. He transferred intensive care unit and respiratory support was started. His physical examination during admission was fever (38.10C), heart (100/min) rates, decreased arterial blood pressure (100/50 mmHg). Leukocyte count 13.21 mm3, hemoglobin 12.7 g/dl, haematocrit 37.5 %, platelet 272.000 mm3, electrolytes were normal. He was treated with intravenous kolloid and crystolloid infusion, dopamine 5 ?g/kg/min. and antipyretic. Cerebrospinal fluid and blood cultures demonstrated
Some cases of bacterial meningitis cannot always be treated intravenously with conventional antimicrobial agents. Inadequate therapy for infections acquired in the intensive care unit (ICU) is associated with increased mortality (6), but the frequent use of broad-spectrum antibiotics means that the ICU environment has become a theatre for selection of multiresistant microorganisms. Infections caused by multiresistant Gram-negative bacteria such as Pseudomonas aeruginosa and
Renal injury is the major adverse effect of colistin. In the largest study to date, published in 1970, frequently reversible renal impairment was found in 20% of patients receiving colistin (8). This possibility of renal toxicity should be considered seriously, especially when colistin is used as a last resort in patients prone to renal dysfunction because of illness severity and ? or sepsis. However, renal function impairment should not be attributed solely to colistin toxicity as other factors, e.g., the development of septic shock and multi-organ failure, may also make a significant contribution. Indeed, previous studies have shown that advanced age, severe sepsis, major surgery, low cardiac output syndrome and hypovolaemia are all common conditions associated with acute renal failure in the ICU setting (9,10,11). Renal function impairment were not development in our patient.
John et al (12) reported intraventricular or intrathecal colistin is effective and well tolerated apart from reversible chemical meningitis/ventriculitis and should be considered for Multidrug-resistant Acinetobacter baumannii (MRAB) CNS infection.
In conclusion, intrathecal colistin appears to be relatively safe and effective in treating severely ill ICU patients with infections caused by multiresistant Gram-negative bacteria. Clinicians should be vigilant for renal function deterioration during colistin therapy
Anaesth Dr Sevtap Hekimoglu Sahin Trakya University Medical Faculty, Department of Anaesthesiology and Reanimation, 22030, Edirne, TURKEY Tel No : 0 90 284 2357641/3200 Fax No: 0 90 284 2358096 E-mail. firstname.lastname@example.org