Published in:
01-06-2010 | Correspondence
Successful treatment of three children with post-neurosurgical multidrug-resistant Acinetobacter baumannii meningitis
Published in: Infection | Issue 3/2010
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In this report we present the clinical features and the treatment of three children with multidrug-resistant (MDR) Acinetobacter baumannii meningitis. All three patients were referred to the Department of Pediatrics from the Department of Neurosurgery, Ankara University Medical Faculty. The clinical, laboratory and treatment characteristics of these patients are summarized in Table 1. For all patients, MDR A. baumannii meningitis was diagnosed with cerebrospinal fluid (CSF) culture isolates susceptible to colistin and resistant to other antibiotics including aminoglycosides, carbapenems, ciprofloxacin, sulbactam and piperacillin-tazobactam.
Table 1
The clinical, laboratory and treatment characteristics of the patients
|
Patient 1
|
Patient 2
|
Patient 3
|
|
|---|---|---|---|
|
Age (months)
|
36
|
168
|
14
|
|
Gender
|
Female
|
Female
|
Male
|
|
Primary disease
|
Choroid plexus papilloma
|
Medulloblastoma
|
Congenital hydocephalus
|
|
Interval between neurosurgical procedure and fever (days)
|
7
|
3
|
2
|
|
Acute phase reactants
|
|||
|
WBC (per mm3)
|
15,300
|
7,100
|
9,900
|
|
ESR (mm/h)
|
132
|
92
|
46
|
|
CRP (mg/dL)
|
13.9
|
14.5
|
9.6
|
|
CSF findings
|
|||
|
WBC (per mm3)
|
400
|
120
|
340
|
|
RBC (per mm3)
|
10
|
10
|
20
|
|
Protein (mg/dL)
|
60
|
114
|
68
|
|
Glucose (mg/dL)
|
12
|
14
|
16
|
|
Culture
|
A. baumannii
|
A. baumannii
|
A. baumannii
|
|
Treatment (BT-ST) (days)
|
Meropenem (1–14)
|
Meropenem (1–30)
|
Meropenem (1–45)
|
|
SAM (2–45)
|
Vancomycin (1–3)
|
Vancomycin (1–3)
|
|
|
Amikacin (2–14)
|
SAM (3–30)
|
Colistin IV (3–45)
|
|
|
Rifampin (2–14)
|
Rifampin (3–30)
|
||
|
Colistin IV (10–45)
|
|||
|
Colistin IT (10–45)
|
|||
|
Treatment time (days)
|
45
|
30
|
45
|
|
Time of CSF sterilization (days)
|
15
|
7
|
9
|