Successful treatment of pan-drug resistant Acinetobacter baumannii meningitis/ventriculitis following craniotomy and external ventricular drainage: a case report

Abstract

Healthcare-associated central nervous system infections are a significant complication for patients undergoing neurosurgical interventions. We present a case of a 6-year-old patient with an embryonal tumor of the central nervous system. Following a craniotomy for the resection of the tumor, an external ventricular drainage was placed. Several weeks after surgery, she developed signs of meningism. Cerebrospinal fluid cultures were positive for pan-drug resistant Acinetobacter baumannii. Several revisions with the insertion of new external valves were done. She was treated with intravenously meropenem and vancomycin combined with colistin administrated intraventricularly. Significant improvement was seen clinically with negative cultures after 2 weeks. The synergistic action of colistin administrated locally combined with systemic antibiotics may be a promising option for critically ill patients with pan-drug resistant A. baumannii central nervous system infection.

Keywords: central nervous system infection; colistin; intraventricular.

Figure 1

Axial cerebral CT scan shows massive hemorrhaging tumor in the right occipital region with perifocal oedema.

Figure 2

Colistin susceptibility by broth microdilution. Resistant isolate (MIC = >16 mg/L).

Figure 3

Amplification and anneal curves of amplified products of OXA-23 and OXA-40 genes of Acinetobacter baumannii.

Figure 4

Cerebral MRI. Axial T1 weighted MRI showing ventriculitis with two external ventricular drainages (EVD) in the frontal horns of lateral ventricles.