Akademik Veri Yönetim Sistemi
Turk Anesteziyoloji ve Reanimasyon Dernegi Dergisi, cilt.36, sa.3, ss.194-196, 2008 (Scopus)
Introduction: The treatment of mutidrug-resistant A. baumannii (MDRA) infections is a serious therapeutic problem, especially in patients with meningitis because antibiotics have a limited ability to penetrate cerebrospinal fluid (CSF). Meningitis due to Acinetobacter spp. has an associated mortality of 20-27 %. We described here a case of meningitis caused by MDRA which was susceptible to colistin and treated with intravenous and intrathecal use of colistin with rifampicin. Cage Report: A 38-year-old male was operated because of schwannoma. On day 9 external CSF shunt was installed. On day 11 the patient presented fever, headache, nausea and vomiting and somnolence. Physical examination revealed a severely ill patient with lathery and meningism. CSF showed pleocytosis (250 cells μL-1; with polymorphonuclear neutrophil dominance (% 100), a protein level of 321 mg dL-1, and a glucose level of 20 mg dL-1 (blood glucose level was 105 mg dL -1). Meropenem (2g q8h), vancomycin (1 g/q12h) and rifampicin (10 mg kg-1 q12h po) were begun. MDRA was isolated from CSF. Meropenem was stopped and the treatment changed to colistin intravenous (2 MIU q(8h) and intratheeal (50 000 IU for the first 3 day and 50.000 IU on alternative days). On day 2 of treatment the CSF was sterile. Treatment was maintained for 21 days and the patient was discharged. Discussion: High use rates of broad-spectrum antibiotics in critically ill patients have been correlated with the emergence of resistance in Acinetobacter strains. Alternative therapies in MDRA infections such as colistin are being increasingly employed. Intrathecal colistin has been used with good results in case of MDRA meningitis. Cure seems to be more frequent among patients receiving combination systemic and intrathecal therapy. Conclusion: Intravenous and intrathecal use of colistin with rifampicin may be a alternative therapy in cases of meningitis caused by A. baumannii resistant to carbapenems and other beta lactam agents.