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).

1) , 6)
Khawcharoenporn T, Apisarnthanarak A, Mundy LM. Intrathecal colistin for drug-resistant Acinetobacter baumannii central nervous system infection: a case series and systematic review. Clin Microbiol Infect. 2010;16(7):888-894. doi:10.1111/j.1469-0691.2009.03019.x
Cascio A, Conti A, Sinardi L, et al. Post-neurosurgical multidrug-resistant Acinetobacter baumannii meningitis successfully treated with intrathecal colistin. A new case and a systematic review of the literature. Int J Infect Dis. 2010;14:e572–9.
Ho YH, Wang LS, Chao HJ, Chang KC, Su CF. Successful treatment of meningitis caused by multidrug-resistant Acinetobacter baumannii with intravenous and intrathecal colistin. J Microbiol Immunol Infect. 2007;40:537–40.
Karageorgopoulos DE, Falagas ME. Current control and treatment of multidrug-resistant Acinetobacter baumannii infections. Lancet Infect Dis. 2008;8:751–62.
Rodríguez Guardado A, Blanco A, Asensi V, et al. Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments. J Antimicrob Chemother. 2008;61(4):908-913. doi:10.1093/jac/dkn018
De Pascale G, Pompucci A, Maviglia R, et al. Successful treatment of multidrug-resistant Acinetobacter baumannii ventriculitis with intrathecal and intravenous colistin. Minerva Anestesiol. 2010;76(11):957-960.
Hoenigl M, Drescher M, Feierl G, et al. Successful management of nosocomial ventriculitis and meningitis caused by extensively drug-resistant Acinetobacter baumannii in Austria. Can J Infect Dis Med Microbiol. 2013;24(3):e88-e90. doi:10.1155/2013/613865
Karaiskos I, Galani L, Baziaka F, Giamarellou H. Intraventricular and intrathecal colistin as the last therapeutic resort for the treatment of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii ventriculitis and meningitis: a literature review. Int J Antimicrob Agents. 2013 Jun;41(6):499-508. doi: 10.1016/j.ijantimicag.2013.02.006. Epub 2013 Mar 16. Review. PubMed PMID: 23507414.
Abdallah M, Alsaleh H, Baradwan A, et al. Intraventricular Tigecycline as a Last Resort Therapy in a Patient with Difficult-to-Treat Healthcare-Associated Acinetobacter baumannii Ventriculitis: a Case Report [published online ahead of print, 2020 Aug 9]. SN Compr Clin Med. 2020;1-5. doi:10.1007/s42399-020-00433-7
Patel JA, Pacheco SM, Postelnick M, Sutton S. Prolonged triple therapy for persistent multidrug-resistant Acinetobacter baumannii ventriculitis. Am J Health Syst Pharm. 2011;68(16):1527-1531. doi:10.2146/ajhp100234
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