Extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacter cloacae ventriculitis...

Area of Science:

• Infectious Diseases
• Neurosurgery
• Microbiology

Background:

• Enterobacter spp. are a growing concern due to intrinsic AmpC beta-lactamase production and acquired extended-spectrum beta-lactamases.
• Carbapenem resistance in Enterobacter cloacae complicates treatment options for serious infections.
• Post-neurosurgical ventriculitis poses significant management challenges.

Observation:

• A patient developed ventriculitis caused by carbapenemase-producing Enterobacter cloacae following neurosurgery.
• Intravenous colistin therapy for six days failed to clear the infection.
• The isolate demonstrated resistance to most antibiotics, with sensitivity only to fosfomycin, tigecycline, and colistin.

Findings:

• Successful eradication of ventriculitis was achieved using intraventricular colistin.
• This treatment approach circumvented the limitations of systemic antibiotic penetration into the cerebrospinal fluid.
• The patient experienced a favorable clinical outcome after intraventricular colistin administration.

Implications:

• Intraventricular colistin represents a viable therapeutic option for carbapenem-resistant Enterobacter cloacae ventriculitis.
• This case underscores the importance of targeted antibiotic delivery for central nervous system infections.
• Further research into intraventricular colistin for multidrug-resistant Gram-negative bacilli meningitis is warranted.