Acinetobacter baumannii ventriculitis treatment

Studies have shown that the combination of intravenous and intrathecal colistin is effective against Acinetobacter baumannii ventriculitis ^{1) 2) 3) 4)}. Rodriguez Guardado et al ⁵⁾ reported 51 cases of nosocomial postsurgical meningitis due to A baumannii. In that study, the combination of intravenous and intrathecal colistin was a safe and useful option for the treatment of Acinetobacter meningitis. Khawcharoenporn et al ⁶⁾ suggested that intrathecal colistin therapy is as efficacious as either primary or adjunct treatment. De Pascale et al ⁷⁾ reported a case involving a 42-year-old man with postneurosurgical ventriculitis caused by A baumannii who was cured using treatment with intrathecal colistin.

Therefore, we conclude that a combination of intrathecal and intravenous colistin may be an effective therapeutic option in the treatment of extensively drug-resistant A baumannii meningitis. Furthermore, the case illustrates the urgent need for new anti-infective agents for treatment of extensively drug-resistant bacterial strains such as the strain described in his report ⁸⁾

In 2013 a review of the available literature regarding intraventricular (IVT) or intrathecal (ITH) administration of colistin in multidrug-resistant (MDR) and extensively drug-resistant (XDR) Acinetobacter baumannii ventriculitis/meningitis was conducted and a total of 83 episodes in 81 patients were identified (71 cases in adults and 10 in children and neonates). Colistin was administered via the IVT and ITH route in 52 and 22 cases, respectively, whilst in 7 cases the exact route was not identified. The median dose of local colistin was 125000 IU (10mg) with a range of 20000 IU (1.6 mg) to 500000 IU (40 mg) in adults, whilst a dose of 2000 IU/kg (0.16 mg/kg) up to 125000 IU (10mg) was used in the paediatric population. The median duration of treatment of IVT/ITH polymyxin E was 18.5 days, whilst the median time to achieve sterilisation of cerebrospinal fluid was 4 days. The rate of successful outcome was 89%, and toxicity related to treatment mainly manifested as reversible chemical ventriculitis/meningitis was reported in nine cases (11%). Nowadays, IVT and ITH colistin represents the last resort treatment of MDR and XDR A. baumannii ventriculitis/meningitis, offering a unique, rather safe and successful mode of therapy ⁹⁾.

Physicians who treat patients with healthcare-associated A. baumannii ventriculitis might resort to IVT tigecycline when they run out of therapeutic options ¹⁰⁾.

Prolonged combination therapy with intraventricular colistin and tobramycin plus i.v. colistin, rifampin, and vancomycin led to the resolution of a persistent central nervous system infection caused by MDR A. baumannii ¹¹⁾.