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.

Gram-Negative Diabetic Foot Osteomyelitis

2013 ◽  
Vol 12 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Javier Aragón-Sánchez ◽  
Benjamin A. Lipsky ◽  
Jose L. Lázaro-Martínez
Keyword(s):  
Blood Cell ◽  
Glycated Hemoglobin ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
White Blood Cell Counts ◽  
Gram Negative Organisms ◽  
Diabetic Foot Osteomyelitis

Osteomyelitis frequently complicates infections in the feet of patients with diabetes. Gram-positive cocci, especially Staphylococcus aureus, are the most commonly isolated pathogens, but gram-negative bacteria also cause some cases of diabetic foot osteomyelitis (DFO). These gram-negatives require different antibiotic regimens than those commonly directed at gram-positives. There are, however, few data on factors related to their presence and how they influence the clinical picture. We conducted a retrospective study to determine the variables associated with the isolation of gram-negative bacteria from bone samples in cases of DFO and the clinical presentation of these infections. Among 341 cases of DFO, 150 had a gram-negative isolate (alone or combined with a gram-positive isolate) comprising 44.0% of all patients and 50.8% of those with a positive bone culture. Compared with gram-positive infections, wounds with gram-negative organisms more often had a fetid odor, necrotic tissue, signs of soft tissue infection accompanying osteomyelitis, and clinically severe infection. By multivariate analysis, the predictive variables related to an increased likelihood of isolating gram-negatives from bone samples were glycated hemoglobin <7% (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.1-3.5) and a wound caused by traumatic injury (OR = 2.0, 95% CI = 1.0-3.9). Overall, patients whose bone samples contained gram-negatives had a statistically significantly higher prevalence of leukocytosis and higher white blood cell counts than those without gram-negatives. In conclusion, gram-negative organisms were isolated in nearly half of our cases of DFO and were associated with more severe infections, higher white blood cell counts, lower glycated hemoglobin levels, and wounds of traumatic etiology.

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 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.

Central Nervous System Infections as a Limiting Factor in the Intelligence of Children with Myelomeningocele

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 338-342 ◽  
Author(s):  
David G. McLone ◽  
Danita Czyzewski ◽  
Anthony J. Raimondi ◽  
Renee C. Sommers
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Limiting Factor ◽  
Central Nervous System Infections ◽  
Multidisciplinary Clinic ◽  
History Of ◽  
Ultimate Outcome ◽  
Iq Scores ◽  
Visual Motor ◽  
Medical Histories

The expectation for intellectual performance of children born with myelomeningocele has often been reported to be significantly decreased due to the presence of hydrocephalus. This study examines the medical histories as well as psychological performance scores of 167 patients observed in our multidisciplinary clinic. Based only on medical histories, the subjects were placed into one of three groups: nonshunted, shunted, and shunted with a history of ventriculitis. Their IQ scores were then compiled and resulted in the following performance breakdown of mean IQs: nonshunted, IQ = 102; shunted, IQ = 95; shunted with a history of ventriculitis, IQ = 72, There were no cases of central nervous system infections in patients who did not have hydrocephalus. Visual motor integration scores were also categorized in the same manner, illustrating a similar trend for severely depressed scores in the group that was shunted and had a history of ventriculitis, while at the same time showing the two remaining groups to be statistically similar. These results have significant importance in the management of hydrocephalus and/or infection as well as indicating the nonpredictability of simple hydrocephalus in the ultimate outcome for intellectual function of those persons born with myelomeningocele.

scholarly journals Etiology associated with developing posthemispherectomy hydrocephalus after resection-disconnection procedures

2013 ◽  
Vol 12 (5) ◽  
pp. 469-475 ◽  
Author(s):  
Jennifer Phung ◽  
Paul Krogstad ◽  
Gary W. Mathern
Keyword(s):  
Blood Cell ◽  
Univariate Analysis ◽  
Cns Infection ◽  
Csf Shunts ◽  
Maximum Daily Temperature ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
History Of ◽  
White Blood Cell Counts ◽  
First Time

Object The authors sought to determine if clinical epilepsy variables, maximum daily temperature (Tmax), and blood and CSF findings were associated with the risk of developing hydrocephalus after first-time resection-disconnection hemispherectomy. Methods Patients who underwent cerebral hemispherectomy in whom a standardized perioperative protocol was used, including the use of ventriculostomies (n = 79), were classified into those who developed and those who did not develop hydrocephalus requiring CSF shunts. The authors compared these 2 groups for clinical variables, Tmax, and blood and CSF studies through postoperative Day 12. Results In this cohort, 30% of the patients required CSF shunts, of which 8% developed late hydrocephalus up to 3 years posthemispherectomy. Multivariate analysis found that etiology was associated with developing posthemispherectomy hydrocephalus. Higher shunt rates were observed for patients with hemimegalencephaly (40%; n = 15) and a history of CNS infection (100%; n = 4) compared with cortical dysplasia (17%; n = 23) and Rasmussen encephalitis (17%; n = 12). In univariate analysis, other factors associated with developing hydrocephalus were elevated maximum daily temperatures, elevated white blood cell counts, decreased CSF protein, and increased CSF red blood cell counts. Conclusions The findings of the study indicate that etiology was the factor most strongly associated with developing posthemispherectomy hydrocephalus. These findings suggest that there are variable mechanisms for developing hydrocephalus after cerebral hemispherectomy depending on the procedure, and in resection-disconnection operations the mechanism may involve changes in CSF bulk flow that varies by histopathology.

scholarly journals Successful Use of Ertapenem for the Treatment of Enterobacter cloacae Complex Infection of the Central Nervous System (CNS)

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Sunish Shah ◽  
Dayna McManus ◽  
Jeffrey E. Topal
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Fluid Collection ◽  
Enterobacter Cloacae ◽  
Central Nervous System Infections ◽  
Culture Collections ◽  
Decompressive Craniotomy ◽  
History Of ◽  
The Central Nervous System ◽  
Enterobacter Cloacae Complex

A 55-year-old female with a past medical history of cocaine use and hypertension was admitted for intracranial hemorrhage requiring right decompressive craniotomy with duraplasty. Due to persistent fevers, a head CT scan obtained on day 28 of hospitalization identified a low-density subgaleal fluid collection overlying the duraplasty. Aspiration of this collection was sent for culture which grew 2+ Enterobacter cloacae complex susceptible to sulfamethoxazole-trimethoprim (SMX-TMP), gentamicin, ciprofloxacin, and ertapenem. Based on these results, the patient was transitioned from empiric vancomycin and ceftazidime to SMX-TMP and metronidazole. Despite treatment with SMX-TMP and metronidazole, aspirated subgaleal collection cultures remained positive for E. cloacae. Intrathecal gentamicin was therefore added; however, repeat subgaleal culture collections remained persistently positive. Given the persistently positive subgaleal culture collections, the patient was transitioned from SMX-TMP and metronidazole to ertapenem. After transition to ertapenem, subgaleal cultures were sterilized and the patient’s infection was resolved. This report suggests ertapenem may be a viable option for central nervous system infections; however, further study is needed.

An Alternative Elastase-mediated Degradation of Fibrinogen and Fibrin Observed in a Patient with Herpes Simplex Encephalitis and Pneumonia

1996 ◽  
Vol 76 (02) ◽  
pp. 184-186 ◽  
Author(s):  
Kenji lijima ◽  
Fumiyo Murakami ◽  
Yasushi Horie ◽  
Katsumi Nakamura ◽  
Shiro Ikawa ◽  
...  
Keyword(s):  
Herpes Simplex ◽  
Blood Cell ◽  
White Blood Cell ◽  
Herpes Simplex Encephalitis ◽  
Pmn Elastase ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
Sds Page ◽  
White Blood Cell Counts ◽  
Pmn Élastase

SummaryA 74-year-old female developed pneumonia following herpes simplex encephalitis. Her white blood cell counts reached 28,400/μl, about 90% of which consisted of granulocytes. The polymorphonuclear (PMN) elastase/α1-arantitrypsin complex levels increased and reached the maximum of 5,019 ng/ml, indicating the release of a large amount of elastase derived from the granulocytes. The mechanism of PMN elastase release was most likely to be granulocyte destruction associated with phagocytosis. The cleavage of fibrinogen and fibrin by PMN elastase, independent of plasmin, was indicated by the presence of the fragments in immunoprecipitated plasma from the patient corresponding to elastase-induced FDP D and DD fragments and the absence of fragments corresponding to plasmin-induced FDP D and DD fragments on SDS-PAGE. These findings suggested that the large amount of PMN elastase released from the excessive numbers of granulocytes in this patient with herpes simplex encephalitis and pneumonia, induced the cleavage of fibrinogen and fibrin without the participation of plasmin.

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