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Intraventricular CNS treatment with Colistin-Tigecycline combination: A case series

Vasiliki Tsolaki1, Marios Karvouniaris1, Efstratios Manoulakas1

  • 1Intensive Care Unit, University Hospital of Larisa, University of Thessaly Medical School, Biopolis 41110, Greece.

Journal of Critical Care
|August 12, 2018
PubMed

Insights

Healthcare-associated ventriculitis and meningitis caused by extensively drug-resistant bacteria can be challenging to treat. Combining intraventricular colistin and tigecycline offers a promising treatment strategy when other methods fail.

Area of Science:

  • Infectious Diseases
  • Neurosurgery
  • Pharmacology

Background:

  • Healthcare-associated ventriculitis and meningitis are severe post-neurosurgical infections.
  • Multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria, including Acinetobacter baumannii and Klebsiella pneumoniae, are increasingly implicated.
  • Limited antimicrobial penetration into the cerebrospinal fluid (CSF) complicates treatment.

Observation:

  • Three cases of XDR ventriculitis/meningitis were treated.
  • Initial treatment with intravenous (IV) and intraventricular (IVT) colistin alone failed.
  • A combination of IVT colistin and off-label IVT tigecycline was administered.

Findings:

  • Successful management of XDR ventriculitis and meningitis was achieved.
  • The combined IVT colistin and tigecycline regimen proved effective.
  • This approach addressed treatment failure with monotherapy.

Implications:

  • Intraventricular colistin and tigecycline combination therapy is a viable option for refractory Gram-negative CNS infections.
  • This strategy may overcome antimicrobial resistance challenges in neurosurgical patients.
  • Further research is warranted to establish optimal protocols for this combination therapy.
Keywords:
Central nervous system infectionColistinExtensive-drug resistant speciesHealth-care associated ventriculitis and meningitisIntraventricular administration of antibioticsTigecycline

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