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Efficacy of intraventricular amikacin treatment in pan-resistant

Mariadelfina Molinaro1, Paola Morelli2, Manuela De Gregori1,3,4

  • 1Clinical and Experimental Pharmacokinetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, m.molinaro@smatteo.pv.it.

Infection and Drug Resistance
|September 15, 2018
PubMed
Abstract

Insights

This case study details a successful treatment for pan-resistant Pseudomonas aeruginosa meningitis using intrathecal amikacin and continuous cefepime infusion. This approach improved clinical outcomes in a complex postsurgical patient.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Pharmacology

Background:

  • Postsurgical meningitis presents a significant clinical challenge, particularly with multidrug-resistant pathogens.
  • External ventricular devices can be associated with an increased risk of central nervous system infections.

Observation:

  • A patient developed meningitis caused by pan-resistant Pseudomonas aeruginosa following surgery for a cavernous angioma.
  • Initial cultures identified Pseudomonas aeruginosa resistant to most antibiotics, with susceptibility limited to colistin.

Findings:

  • Two prior therapeutic regimens proved ineffective in treating the resistant meningitis.
  • A combination of intrathecal amikacin and continuous intravenous cefepime infusion, along with intravenous amikacin, led to clinical improvement.

Implications:

  • This case highlights the potential efficacy of combination antibiotic therapy, including intrathecal and continuous infusion strategies, for pan-resistant bacterial meningitis.
  • Monitoring antibiotic concentrations and bactericidal activity in cerebrospinal fluid is crucial for optimizing treatment in challenging multidrug-resistant meningitis cases.
Keywords:
Pseudomonas aeruginosaamikacinpan-resistant meningitis

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