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Recurrence of Postneurosurgical Central Nervous System Infection Caused by Acinetobacter baumannii in a Critically
Giuseppe Accurso1, Angelica Ancona1, Giovanni Marco Costa1
1Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Sicily, Italy.
Introduction:
Acinetobacter baumannii (A. baumannii), a gram-negative bacterium, has become a significant hospital pathogen and the cause of severe nosocomial infections, especially in the intensive care unit (ICU). Bacterial meningitis is a recognized complication that can occur after neurosurgery, and the number of cases of multidrug-resistant (MDR) meningitis caused by A. baumannii is increasing. Critically ill patients in the ICU are at high risk, and the consequences are potentially fatal. Cefiderocol is a novel cephalosporin that can treat carbapenem-resistant infections in patients with limited treatment options. No clinical trials have investigated its capability to penetrate cerebrospinal fluid.
Case Presentation:
We describe the case of a 66-year-old man who was admitted to our neurointensive care unit after head trauma. On the CT scan performed on admission to the hospital, there was evidence of a subdural hematoma and subarachnoid and intraparenchymal hemorrhages in the frontotemporal region bilaterally. The patient then underwent a decompressive craniectomy. During hospitalization and following cranioplasty, the patient experienced a central nervous recurrence of carbapenem-resistant A. baumannii (CRAB) meningitis, which was treated with cefiderocol, resulting in a resolution of signs and symptoms of infection within a few days.
Conclusion:
We present the first case of CRAB meningitis treated with this cefiderocol dosing regimen. In our case of postneurosurgical MDR meningitis reinfection caused by A. baumannii, cefiderocol as monotherapy brought about a clinical and microbiological cure in both blood and cerebrospinal fluid without the occurrence of adverse effects such as seizure.
Insights
This case study shows cefiderocol effectively treated multidrug-resistant Acinetobacter baumannii meningitis in a neurocritical care patient. The novel cephalosporin achieved a cure in both blood and cerebrospinal fluid without adverse effects.
Area of Science:
- Infectious Diseases
- Neuroscience
- Pharmacology
Background:
- Acinetobacter baumannii is a major hospital pathogen causing severe nosocomial infections, particularly in ICUs.
- Multidrug-resistant (MDR) Acinetobacter baumannii meningitis is an increasing threat, especially post-neurosurgery.
- Cefiderocol is a novel cephalosporin for carbapenem-resistant infections, but its efficacy in cerebrospinal fluid is not well-established.
Purpose of the Study:
- To report the first case of carbapenem-resistant Acinetobacter baumannii (CRAB) meningitis treated with cefiderocol.
- To evaluate the efficacy and safety of cefiderocol in treating post-neurosurgical CRAB meningitis.
- To assess cefiderocol's penetration and activity in the cerebrospinal fluid.
Main Methods:
- A 66-year-old male patient with head trauma developed recurrent CRAB meningitis post-neurosurgery.
- Treatment involved cefiderocol monotherapy.
- Clinical and microbiological outcomes were monitored in blood and cerebrospinal fluid.
Main Results:
- Cefiderocol monotherapy led to a clinical and microbiological cure of CRAB meningitis.
- Infection resolved within days, with clearance in both blood and cerebrospinal fluid.
- No adverse effects, such as seizures, were observed during treatment.
Conclusions:
- Cefiderocol is a viable therapeutic option for treating CRAB meningitis, even in complex post-neurosurgical cases.
- This case demonstrates cefiderocol's effectiveness in eradicating CRAB from both systemic circulation and the central nervous system.
- Further clinical trials are warranted to confirm cefiderocol's role in managing CNS infections caused by MDR pathogens.
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