Post-neurosurgical multidrug-resistant Acinetobacter baumannii meningitis successfully treated with intrathecal colistin. A new case and a systematic review of the literature

Cascio, Antonio; Conti, Alfredo; Sinardi, Luca; Iaria, Chiara; Angileri, Filippo Flavio; Stassi, Giovanna; David, Teresa; Versaci, Antonio; Iaria, Maurizio; David, Antonio

doi:10.1016/j.ijid.2009.06.032

« Previous Next »International Journal of Infectious Diseases
Volume 14, Issue 7 , Pages e572-e579, July 2010

Post-neurosurgical multidrug-resistant Acinetobacter baumannii meningitis successfully treated with intrathecal colistin. A new case and a systematic review of the literature

Antonio Cascio
- Tropical and Parasitological Diseases Unit, Department of Human Pathology, University of Messina, Via Consolare Valeria n. 1, 98125 Messina, Italy
- Corresponding author. Tel.: +39 090 2213680; fax: +39 090 692685.
Alfredo Conti
- Department of Neurosurgery, University of Messina, Messina, Italy
Luca Sinardi
- Department of Neuroscience, Psychiatric and Anesthesiological Sciences, University of Messina, Messina, Italy
Chiara Iaria
- AILMI (Associazione Italiana per la Lotta contro le Malattie Infettive; Italian Association for the Control of Infectious Diseases), University of Messina, Messina, Italy
Filippo Flavio Angileri
- Department of Neurosurgery, University of Messina, Messina, Italy
Giovanna Stassi
- Microbiology Unit, University of Messina, Messina, Italy
Teresa David
- Department of Neuroscience, Psychiatric and Anesthesiological Sciences, University of Messina, Messina, Italy
Antonio Versaci
- Department of Neuroscience, Psychiatric and Anesthesiological Sciences, University of Messina, Messina, Italy
Maurizio Iaria
- Division of General Surgery, Department of Human Pathology, University of Messina, Messina, Italy
Antonio David
- Department of Neuroscience, Psychiatric and Anesthesiological Sciences, University of Messina, Messina, Italy

Received 23 February 2009; received in revised form 25 June 2009; accepted 29 June 2009. published online 05 November 2009.

Corresponding Editor: J. Peter Donnelly, Nijmegen, the Netherlands

Summary

Introduction

Post-neurosurgical nosocomial meningitis has become an important subgroup of bacterial meningitis in the hospital setting. The increase in meningitis caused by multidrug-resistant (MDR) Acinetobacter baumannii has resulted in a significant reduction in available treatment options.

Case report and literature review

We report the case of a 36-year-old man with a complex craniofacial trauma, who developed a nosocomial meningitis due to MDR A. baumannii that was cured by intrathecal colistin. The case is contextualized among all the published cases of Acinetobacter meningitis treated with topical colistin found through a MEDLINE search of the literature. To date, including the present case, eight reported cases of Acinetobacter meningitis have been treated with colistin administered by an intrathecal route and 24 by an intraventricular route. The daily dose of colistin used ranged from 1.6mg every 24h to 20mg every 24h in adult patients. The median time necessary to obtain cerebrospinal fluid sterilization was 4.1 days, and treatment was always successful even if in two cases Acinetobacter meningitis relapsed. Toxicity probably or possibly related to the topical administration of colistin was noted in five out of the 32 patients.