Prolonged triple therapy for persistent multidrug-resistant Acinetobacter baumannii ventriculitis.

Area of Science:

• Infectious Diseases
• Neuroscience
• Pharmacology

Background:

• Central nervous system infections caused by multidrug-resistant (MDR) Acinetobacter baumannii pose significant treatment challenges.
• Ventriculitis, an inflammation of the brain's ventricles, requires aggressive management due to its potential for severe neurological sequelae.

Observation:

• A case of persistent MDR A. baumannii ventriculitis in a patient with a history of craniotomy and cerebrospinal fluid leak.
• Initial cultures revealed MDR A. baumannii, coagulase-negative Staphylococcus, and methicillin-resistant Staphylococcus aureus.

Findings:

• A novel, prolonged combination antimicrobial therapy was administered, including intravenous (IV) and intraventricular (IVT) colistin, IVT tobramycin, IV rifampin, and IV vancomycin.
• The patient received 36 days of IVT colistin, 40 days of IVT tobramycin, 51 days of IV colistin and rifampin, and 56 days of IV vancomycin.
• Clinical manifestations improved, and the central nervous system infection was eradicated.

Implications:

• Prolonged combination therapy, including intraventricular administration of antimicrobials, can be effective in treating persistent MDR A. baumannii ventriculitis.
• This case highlights a potential therapeutic strategy for challenging central nervous system infections.
• Successful treatment led to patient discharge, although with residual neurological and renal sequelae requiring rehabilitation and hemodialysis.