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Treatment of multidrug-resistant Acinetobacter baumannii meningitis with ampicillin/sulbactam
M E Jiménez-Mejías1, J Pachón, B Becerril
1Neurosurgery Department, University Hospital Virgen del Rocio, Seville, Spain.
Abstract:
The clinical features and the outcomes of eight cases of nosocomial Acinetobacter baumannii meningitis treated with ampicillin/sulbactam are reported. All the patients had fever, neck stiffness or meningeal signs, and a low consciousness level, and in their cerebrospinal fluid (CSF), pleocytosis, a low glucose level, and an elevated protein level were noted. For all CSF isolates of A. baumannii, the MIC of ampicillin/sulbactam was < or = 8/4 microg/mL. The MICs of sulbactam by microdilution in two cases were 4 microg/mL. All isolates were resistant to cefotaxime, ceftriaxone, ceftazidime, ureidopenicillins, ciprofloxacin, and gentamicin. Seven isolates were resistant to imipenem. A. baumannii was isolated from other samples in seven episodes. All patients were treated with ampicillin/sulbactam (seven with 2 g/l g every 6 hours and one with 2 g/l g every 8 hours). Six patients were cured and two patients died of meningitis. There were no side effects with the ampicillin/sulbactam treatment. In conclusion, ampicillin/sulbactam may be effective as therapy for meningitis caused by A. baumanii resistant to imipenem and other beta-lactam drugs.
Insights
Ampicillin/sulbactam effectively treated nosocomial Acinetobacter baumannii meningitis, even in cases resistant to other drugs. This antibiotic combination offers a viable therapeutic option for severe bacterial meningitis.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Neurology
Background:
- Nosocomial meningitis caused by Acinetobacter baumannii presents a significant clinical challenge due to increasing antimicrobial resistance.
- Limited effective treatment options exist for Acinetobacter baumannii meningitis, particularly for strains resistant to carbapenems and other beta-lactam agents.
Purpose of the Study:
- To report the clinical features and outcomes of patients with nosocomial Acinetobacter baumannii meningitis treated with ampicillin/sulbactam.
- To evaluate the efficacy and safety of ampicillin/sulbactam in treating meningitis caused by multidrug-resistant Acinetobacter baumannii.
Main Methods:
- Retrospective case series of eight patients diagnosed with Acinetobacter baumannii meningitis.
- Clinical data, cerebrospinal fluid (CSF) analysis, and antimicrobial susceptibility testing (AST) were reviewed.
- Patients received ampicillin/sulbactam treatment at dosages of 2 g every 6 or 8 hours.
Main Results:
- All Acinetobacter baumannii isolates showed susceptibility to ampicillin/sulbactam (MIC <= 8/4 microg/mL).
- Isolates were resistant to cefotaxime, ceftriaxone, ceftazidime, ureidopenicillins, ciprofloxacin, gentamicin, and often imipenem.
- Six out of eight patients were cured, with no reported side effects from ampicillin/sulbactam treatment.
Conclusions:
- Ampicillin/sulbactam demonstrates potential efficacy in treating nosocomial Acinetobacter baumannii meningitis, including imipenem-resistant strains.
- The drug combination represents a valuable therapeutic alternative for meningitis caused by multidrug-resistant Acinetobacter baumannii.