scholarly journals Successful Management of Nosocomial Ventriculitis and Meningitis Caused by Extensively Drug-ResistantAcinetobacter baumanniiin Austria

2013 ◽  
Vol 24 (3) ◽  
pp. e88-e90 ◽  
Author(s):  
M Hoenigl ◽  
M Drescher ◽  
G Feierl ◽  
T Valentin ◽  
G Zarfel ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Nosocomial Infections ◽  
Antimicrobial Agents ◽  
Northern Italy ◽  
Drug Resistant ◽  
Central Nervous System Infections ◽  
Successful Management ◽  
Gram Negative ◽  
Extensively Drug Resistant

Nosocomial infections caused by the Gram-negative coccobacillusAcinetobacter baumanniihave substantially increased over recent years. BecauseAcinetobacteris a genus with a tendency to quickly develop resistance to multiple antimicrobial agents, therapy is often complicated, requiring the return to previously used drugs. The authors report a case of meningitis due to extensively drug-resistantA baumanniiin an Austrian patient who had undergone neurosurgery in northern Italy. The case illustrates the limits of therapeutic options in central nervous system infections caused by extensively drug-resistant pathogens.

Meropenem Administered as a Prolonged Infusion to Treat Serious Gram-Negative Central Nervous System Infections

2004 ◽  
Vol 24 (6) ◽  
pp. 803-807 ◽  
Author(s):  
Blair Capitano ◽  
David P. Nicolau ◽  
Brian A. Potoski ◽  
Karin E. Byers ◽  
Michael Horowitz ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Infections ◽  
Prolonged Infusion ◽  
Gram Negative

scholarly journals Nosocomial infections in patients with acute central nervous system infections

2007 ◽  
Vol 60 (1-2) ◽  
pp. 12-18
Author(s):  
Olgica Gajovic ◽  
Predrag Canovic ◽  
Zeljko Mijailovic ◽  
Zorica Lazic
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Nosocomial Infections ◽  
Clinical Manifestations ◽  
Central Nervous System Infections ◽  
Current Increase ◽  
Urinary Infections ◽  
Clinical Center ◽  
Clinical Presentations

Due to current increase in the rate of nosocomial infections, our objective was to examine the frequency, risk factors, clinical presentation and etiology of nosocomial infections in patients with central nervous system infections. 2246 patients with central nervous system infections, treated in the intensive care units of the Institute of Infectious and Tropical Diseases, Clinical Center of Serbia in Belgrade and at the Department of Infectious Diseases of the Clinical Hospital Center Kragujevac, were included in this retrospective and prospective study. Clinical manifestations of nosocomial infections were registered in 180 (12.7%) patients. Direct risk factors for nosocomial infections were: venous lines, urinary catheter, length of stay over 20 days, inhibitors of gastric secretion, consciousness disorders and coma, endotracheal intubation, tracheotomy and controlled ventilation for 5 days or more. The most frequent clinical presentations of nosocomial infections were: tract urinary infections, bacteriemia/sepsis and nosocomial pneumonia. Significantly higher frequency of death outcomes was registered in patients with nosocomial infections.

Intrathecal Colistin and Sterilization of Resistant Pseudomonas Aeruginosa Shunt Infection

2005 ◽  
Vol 39 (5) ◽  
pp. 949-952 ◽  
Author(s):  
Andrea L Quinn ◽  
Jorge P Parada ◽  
Jaime Belmares ◽  
J Paul O'Keefe
Keyword(s):  
Central Nervous System ◽  
Pseudomonas Aeruginosa ◽  
Nervous System ◽  
Renal Function ◽  
Central Nervous System Infections ◽  
Gram Negative ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
History Of ◽  
White Blood Cell Counts

OBJECTIVE: To report 2 cases of multidrug-resistant (MDR) Pseudomonas aeruginosa meningitis and ventriculo-peritoneal shunt (VPS) infection successfully sterilized with intrathecal colistin 10 mg/day after development of nephrotoxicity associated with intravenous administration. CASE SUMMARIES: Case 1. A 69-year-old African American woman with a history of subarachnoid hemorrhage and hydrocephalus requiring VPS placement was admitted with VPS infection and meningitis. Cerebrospinal fluid (CSF) cultures revealed MDR P. aeruginosa susceptible only to colistin. Intravenous colistin was initiated but rapidly discontinued due to development of renal dysfunction. Intravenous colistin was the probable cause of the adverse effect. Intrathecal colistin was initiated via an externalized VPS, with subsequent improvement in white blood cell counts in the CSF. Follow-up CSF cultures remained sterile and renal function returned to baseline. Case 2. A 69-year-old white woman with a history of subarachnoid hemorrhage, hydrocephalus, and VPS was transferred from an extended-care facility for management of a VPS infection. CSF cultures revealed MDR P. aeruginosa susceptible only to colistin. Intravenous colistin was initiated but subsequently discontinued due to worsening renal function that, as with the first case, probably correlated with colistin administration and persisted despite dose adjustment. Therapy was changed to intrathecal administration, with subsequent normalization of her CSF white blood cell counts and sterilization of cultures. DISCUSSION: The limited availability of antibiotics for treatment of highly resistant or MDR gram-negative organisms has prompted clinicians to reconsider the use of older drugs. Prior reports have suggested that intravenous colistin is a potential alternative for treating highly resistant gram-negative central nervous system infections, specifically Acinetobacter, but its use is limited by nephrotoxicity. Our experience suggests that intrathecal colistin is a potentially curative intervention for the treatment of severe MDR P. aeruginosa meningitis and VPS infections in patients in whom intravenous colistin is not an option. CONCLUSIONS: Intrathecal use of colistin is a potentially safe, effective, and viable treatment option for MDR P. aeruginosa central nervous system infections when intravenous administration is not feasible.

scholarly journals A combined strategy for postoperative patients with central nervous system infections caused by XDR/PDR Acinetobacter baumannii: a retrospective study

2019 ◽  
Author(s):  
Jianbo Chang ◽  
Yihao Chen ◽  
He Wang ◽  
Xiaojun Ma ◽  
Xiao Zhang ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Acinetobacter Baumannii ◽  
Antimicrobial Agents ◽  
Combined Therapy ◽  
Positive Culture ◽  
Central Nervous System Infections ◽  
Intractable Problems ◽  
The Individual ◽  
Combined Strategy

Abstract Background Postoperative central nervous system infections (PCNSIs) caused by extensively drug-resistant (XDR) or pandrug-resistant (PDR) Acinetobacter baumannii are rare but intractable problems. To investigate a potential combined strategy to treat AB organisms that are resistant to not only meropenem but also colistin. Methods We retrospectively reviewed cerebrospinal fluid positive culture isolates of AB in patients who underwent neurosurgery. Medical records were collected by standard forms and analyzed. Results 16 patients met the criteria and most patients were middle-aged men who had undergone craniotomy or endonasal transsphenoidal surgery. 68.8% AB isolates were XDR bacteria, and 18.8% isolates were PDR bacteria. 12 patients were treated by meropenem-based regimen strategy. Another 4 patients were administered tetracycline-based regimens. 93.8% patients were treated with therapeutic drainage, and strict hygiene rules were followed. Finally, 12 patients survived their infections, and the average Glasgow Outcome Scale score was 2.9±1.4 at discharge. And the mortality rates of carbapenem-resistant AB (CRAB) were 8.3%. Conclusions PCNSIs caused by XDR/PDR AB are a rare and serious complication. Combined therapy based on the individual situation, including appropriate antimicrobial agents, surgical management and strict hygiene management, might be an effective therapeutic strategy.

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