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Published on: February 9, 2011

Acinetobacter species meningitis in children: a case series from Karachi, Pakistan

Ali Faisal Saleem1, Muhammad Shafaat Shah, Abdul Sattar Shaikh

  • 1The Aga Khan University Hospital, Karachi, Pakistan. ali.saleem@aku.edu

Journal of Infection in Developing Countries
|November 25, 2011
PubMed
Abstract

Insights

Treating multidrug-resistant Acinetobacter meningitis in children, especially post-neurosurgery, requires early antimicrobial therapy. Intrathecal polymyxin B shows promise for Acinetobacter CNS infections.

Area of Science:

  • Pediatric Infectious Diseases
  • Neurocritical Care
  • Antimicrobial Resistance

Background:

  • Multidrug-resistant Acinetobacter infections, particularly meningitis, present significant treatment challenges due to limited effective antibiotics with central nervous system (CNS) penetration.
  • Acinetobacter meningitis in children is rare but poses a serious threat, especially in hospital settings.

Observation:

  • A retrospective review of eight pediatric cases of Acinetobacter meningitis in Pakistan was conducted.
  • Five patients had pan-resistant isolates, and two had multidrug-resistant isolates.
  • Five patients underwent neurosurgery with external ventricular drain (EVD) placement prior to meningitis diagnosis.

Findings:

  • Intravenous (IV) and intrathecal (IT) polymyxin B was administered to most patients, achieving cerebrospinal fluid (CSF) culture negativity in all.
  • Mortality occurred in two patients, one with pan-resistant and one with multidrug-resistant Acinetobacter.
  • Successful treatment was achieved in most cases, with a mean hospitalization of 38.7 days.

Implications:

  • Early and appropriate antimicrobial therapy, including IT polymyxin B, can be effective for treating challenging Acinetobacter meningitis in pediatric neurosurgical patients.
  • Further research is needed to define the optimal role of IT polymyxin B, whether as monotherapy or combination therapy.
  • This study highlights the potential for successful management of severe Acinetobacter CNS infections with targeted antimicrobial strategies.

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