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Multidrug-resistant Gram-negative post-neurosurgical meningitis and the role of intraventricular colistin: a case
Chiara Iaria1, Giuseppe Roberto Giammalva2, Daria Spicola1
1U.O.C Malattie Infettive, A.R.N.A.S. Civico-Di Cristina-Benfratelli, Palermo, Italy.
Abstract:
The aim of this study was to report the clinical experience of intraventricular colistin for the treatment of multi-resistant Gram-negative post-surgical meningitis in a tertiary hospital. Post-neurosurgical meningitis (PNM) is one of the life-threatening complications of neurosurgical procedures, and is frequently sustained by Acinetobacter baumannii and Klebsiella pneumoniae. Here we describe our experience of five cases of PNM caused by gram-negative multi-drug resistant (MDR) bacteria, treated with intraventricular (IVT) colistin, admitted to the Neurosurgery Unit of A.R.N.A.S. Civico of Palermo, Italy, from January 2016 to June 2020. In four patients the cerebrospinal fluid (CSF) culture was positive for A. baumannii, while in one patient it was positive for K. pneumoniae. IVT colistin therapy was administered for a median time of 18 days (range 7-29). The median time to CSF negativization was seven days (range 5-29). IVT colistin administration was associated with intravenous administration of meropenem and colistin in all patients. As regards clinical outcome, four patients were successfully treated and were subsequently discharged, while one patient died following respiratory complications and subsequent brain death. IVT colistin administration is an effective therapy for MDR post-neurosurgical meningitis and its administration is also prescribed by guidelines. However, IVT therapy for Gram-negative ventriculitis is mostly understudied. Our paper adds evidence for such treatment that can actually be considered life-saving.
Insights
Intraventricular colistin effectively treats multi-drug resistant Gram-negative meningitis after surgery. This life-saving therapy, often used with other antibiotics, clears infections and improves patient outcomes in challenging neurosurgical cases.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Pharmacology
Background:
- Post-neurosurgical meningitis (PNM) is a severe complication often caused by multi-drug resistant (MDR) Gram-negative bacteria like Acinetobacter baumannii and Klebsiella pneumoniae.
- Treatment options for MDR Gram-negative PNM are limited, necessitating exploration of alternative therapeutic strategies.
Purpose of the Study:
- To report the clinical experience and outcomes of using intraventricular colistin for treating MDR Gram-negative post-surgical meningitis.
- To evaluate the efficacy and safety of intraventricular colistin in a tertiary hospital setting.
Main Methods:
- Retrospective case series of five patients with MDR Gram-negative PNM treated with intraventricular colistin.
- Cerebrospinal fluid (CSF) cultures were monitored for bacterial clearance.
- Patients also received intravenous meropenem and colistin concurrently.
Main Results:
- Four out of five patients achieved successful treatment and were discharged.
- Median time to CSF culture negativization was seven days.
- Intraventricular colistin was administered for a median of 18 days.
Conclusions:
- Intraventricular colistin is an effective and potentially life-saving treatment for MDR Gram-negative post-surgical meningitis.
- Further research into intraventricular therapy for Gram-negative ventriculitis is warranted to support clinical guidelines.
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