Intraventricular or intrathecal colistin for the treatment of central nervous system infections caused by multidrug-resistant Gram-negative bacteria

2014 ◽  
Vol 12 (4) ◽  
pp. 471-478 ◽  
Author(s):  
Roberto Imberti ◽  
Giorgio Antonio Iotti ◽  
Mario Regazzi
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Central Nervous System Infections ◽  
Gram Negative

scholarly journals Evaluation of Intraventricular/Intrathecal Antimicrobial Therapy in the Treatment of Nosocomial Meningitis Caused by Multidrug-Resistant Gram-Negative Bacteria after Central Nervous System Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Nagehan Didem Sari ◽  
Sevim Baltali ◽  
Istemi Serin ◽  
Veysel Antar
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Success ◽  
Day Treatment ◽  
Treatment Options ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Mortality And Morbidity ◽  
Postoperative Meningitis

Introduction. Postoperative meningitis (POM) is an infection with high mortality and morbidity following central nervous system surgery due to trauma or tumor. Intrathecal/intraventricular (IT/IVT) antibiotic administrations have been considered as the last treatment options for multidrug-resistance (MDR) Gram-negative bacteria that do not respond to intravenous (IV) regimens. IT/IVT can bypass the blood-brain barrier, obtain a more effective antibiotic concentration in CSF, and reduce systemic side effects. We aimed to determine the characteristics of postoperative patients who were diagnosed with MDR POM during follow-up in our intensive care unit (ICU). Material and Methods. In this study, POM patients who were followed up in ICU after the central nervous system intervention between January 2016 and December 2019 and whose MDR Gram-negative bacteria were isolated from CSF were evaluated. As soon as the patients were diagnosed with POM, a catheter was inserted and treatment was started. Results. Microbiological eradication was achieved in 3 ± 0.8 days with 30 mg/day amikacin treatment in POM due to K. pneumoniae and 3.7 ± 1.95 days with colistin sodium 10 mg/day treatment in POM due to A. baumannii via IT/IVT catheter. IT/IVT treatment was utilized for a median of 10 days and continued until the defined cure criteria were achieved. While cure was achieved in 6 of 14 POM cases, 8 of them were exitus. Discussion and Conclusion. To avoid the severe consequences of postoperative meningitis, acting fast and adding IT/IVT methods to parenteral administration routes by considering the distribution of MDR microorganisms within the hospital while planning effective treatment will increase the clinical success.

scholarly journals Visualizing the Potential Impairment of Polymyxin B to Central Nervous System Through MR Susceptibility-Weighted Imaging

2021 ◽  
Vol 12 ◽  
Author(s):  
Ni Zhang ◽  
Lichong Zhu ◽  
Qiuhong Ouyang ◽  
Saisai Yue ◽  
Yichun Huang ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Polymyxin B ◽  
Susceptibility Weighted Imaging ◽  
Gram Negative Bacteria ◽  
Severe Toxicity ◽  
Gram Negative ◽  
The Impact

Polymyxin B (PMB) exert bactericidal effects on the cell wall of Gram-negative bacteria, leading to changes in the permeability of the cytoplasmic membrane and resulting in cell death, which is sensitive to the multi-resistant Gram-negative bacteria. However, the severe toxicity and adverse side effects largely hamper the clinical application of PMB. Although the molecular pathology of PMB neurotoxicity has been adequately studied at the cellular and molecular level. However, the impact of PMB on the physiological states of central nervous system in vivo may be quite different from that in vitro, which need to be further studied. Therefore, in the current study, the biocompatible ultra-uniform Fe3O4 nanoparticles were employed for noninvasively in vivo visualizing the potential impairment of PMB to the central nervous system. Systematic studies clearly reveal that the prepared Fe3O4 nanoparticles can serve as an appropriate magnetic resonance contrast agent with high transverse relaxivity and outstanding biosafety, which thus enables the following in vivo susceptibility-weighted imaging (SWI) studies on the PMB-treated mice models. As a result, it is first found that the blood-brain barrier (BBB) of mice may be impaired by successive PMB administration, displaying by the discrete punctate SWI signals distributed asymmetrically across brain regions in brain parenchyma. This result may pave a noninvasive approach for in-depth studies of PMB medication strategy, monitoring the BBB changes during PMB treatment, and even assessing the risk after PMB successive medication in multidrug-resistant Gram-negative bacterial infected patients from the perspective of medical imaging.

Meropenem Administered as a Prolonged Infusion to Treat Serious Gram-Negative Central Nervous System Infections

2004 ◽  
Vol 24 (6) ◽  
pp. 803-807 ◽  
Author(s):  
Blair Capitano ◽  
David P. Nicolau ◽  
Brian A. Potoski ◽  
Karin E. Byers ◽  
Michael Horowitz ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Infections ◽  
Prolonged Infusion ◽  
Gram Negative

scholarly journals Successful Management of Nosocomial Ventriculitis and Meningitis Caused by Extensively Drug-ResistantAcinetobacter baumanniiin Austria

2013 ◽  
Vol 24 (3) ◽  
pp. e88-e90 ◽  
Author(s):  
M Hoenigl ◽  
M Drescher ◽  
G Feierl ◽  
T Valentin ◽  
G Zarfel ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Nosocomial Infections ◽  
Antimicrobial Agents ◽  
Northern Italy ◽  
Drug Resistant ◽  
Central Nervous System Infections ◽  
Successful Management ◽  
Gram Negative ◽  
Extensively Drug Resistant

Nosocomial infections caused by the Gram-negative coccobacillusAcinetobacter baumanniihave substantially increased over recent years. BecauseAcinetobacteris a genus with a tendency to quickly develop resistance to multiple antimicrobial agents, therapy is often complicated, requiring the return to previously used drugs. The authors report a case of meningitis due to extensively drug-resistantA baumanniiin an Austrian patient who had undergone neurosurgery in northern Italy. The case illustrates the limits of therapeutic options in central nervous system infections caused by extensively drug-resistant pathogens.

scholarly journals Using Therapeutic Drug Monitoring to Treat KPC-Producing Klebsiella pneumoniae Central Nervous System Infection With Ceftazidime/Avibactam

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Mohamad Yasmin ◽  
Jennifer Hanrahan ◽  
Steven Marshall ◽  
Thomas P Lodise ◽  
Liang Chen ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Therapeutic Drug Monitoring ◽  
Klebsiella Pneumoniae ◽  
Drug Monitoring ◽  
Central Nervous System Infection ◽  
Multidrug Resistant ◽  
Therapeutic Drug ◽  
Central Nervous System Infections ◽  
Klebsiella Pneumoniae Carbapenemase

Abstract This report describes the treatment of Klebsiella pneumoniae carbapenemase (KPC)–3–producing multidrug-resistant K. pneumoniae with ceftazidime/avibactam (CAZ-AVI) in a patient who developed postneurosurgical meningitis and bacteremia. Therapeutic drug monitoring of cerebrospinal fluid and blood samples demonstrated CAZ-AVI concentration levels 20-fold greater than the minimum inhibitory concentration in the first 60 minutes postinfusion, providing evidence for the utility of CAZ-AVI in treating KPC–Klebsiella pneumoniae central nervous system infections.

Intrathecal Colistin and Sterilization of Resistant Pseudomonas Aeruginosa Shunt Infection

2005 ◽  
Vol 39 (5) ◽  
pp. 949-952 ◽  
Author(s):  
Andrea L Quinn ◽  
Jorge P Parada ◽  
Jaime Belmares ◽  
J Paul O'Keefe
Keyword(s):  
Central Nervous System ◽  
Pseudomonas Aeruginosa ◽  
Nervous System ◽  
Renal Function ◽  
Central Nervous System Infections ◽  
Gram Negative ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
History Of ◽  
White Blood Cell Counts

OBJECTIVE: To report 2 cases of multidrug-resistant (MDR) Pseudomonas aeruginosa meningitis and ventriculo-peritoneal shunt (VPS) infection successfully sterilized with intrathecal colistin 10 mg/day after development of nephrotoxicity associated with intravenous administration. CASE SUMMARIES: Case 1. A 69-year-old African American woman with a history of subarachnoid hemorrhage and hydrocephalus requiring VPS placement was admitted with VPS infection and meningitis. Cerebrospinal fluid (CSF) cultures revealed MDR P. aeruginosa susceptible only to colistin. Intravenous colistin was initiated but rapidly discontinued due to development of renal dysfunction. Intravenous colistin was the probable cause of the adverse effect. Intrathecal colistin was initiated via an externalized VPS, with subsequent improvement in white blood cell counts in the CSF. Follow-up CSF cultures remained sterile and renal function returned to baseline. Case 2. A 69-year-old white woman with a history of subarachnoid hemorrhage, hydrocephalus, and VPS was transferred from an extended-care facility for management of a VPS infection. CSF cultures revealed MDR P. aeruginosa susceptible only to colistin. Intravenous colistin was initiated but subsequently discontinued due to worsening renal function that, as with the first case, probably correlated with colistin administration and persisted despite dose adjustment. Therapy was changed to intrathecal administration, with subsequent normalization of her CSF white blood cell counts and sterilization of cultures. DISCUSSION: The limited availability of antibiotics for treatment of highly resistant or MDR gram-negative organisms has prompted clinicians to reconsider the use of older drugs. Prior reports have suggested that intravenous colistin is a potential alternative for treating highly resistant gram-negative central nervous system infections, specifically Acinetobacter, but its use is limited by nephrotoxicity. Our experience suggests that intrathecal colistin is a potentially curative intervention for the treatment of severe MDR P. aeruginosa meningitis and VPS infections in patients in whom intravenous colistin is not an option. CONCLUSIONS: Intrathecal use of colistin is a potentially safe, effective, and viable treatment option for MDR P. aeruginosa central nervous system infections when intravenous administration is not feasible.

scholarly journals Epidemiology, Pathogens Distribution, Antibiotic Susceptibility and the Risk Factors for Mortality of Patients With Central Nervous System Infections: a Retrospective Study From 2012 to 2019 in a Teaching Hospital in China

2021 ◽  
Author(s):  
Zheng Zhang ◽  
Yan Song ◽  
Jianbang Kang ◽  
Surong Duan ◽  
Qi Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Retrospective Study ◽  
Pulmonary Infection ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Cns Infections

Abstract Background: Central nervous system (CNS) infections are relatively rare but associated with high mortality worldwide. Empirical antimicrobial therapy is crucial for the prognosis of patients with CNS infections, which should be based on the knowledge of pathogens distribution and antibiotic sensitivities. China is a vast country, and the pathogens distribution varies nationwide. The aim of this study is to investigate the features of pathogens in patients with CNS infections in north China and we tried to evaluate the risk factors for mortality.Methods: We retrospectively analyzed the patients with positive cerebrospinal fluid (CSF) culture in a teaching hospital between January 2012 and December 2019. The following information were collected: demographic characteristics, laboratory data, causative organisms and antimicrobial susceptibility results. Univariate analysis and binary logistic regression analysis were performed to identify the risk factors for mortality.Results: In this eight-year retrospective study, a total of 72 patients were diagnosed with CNS infections and 86 isolates were identified. Among all the microorganisms detected, Gram-positive strains consisted of 59.3%, Gram-negative bacteria of 30.2% and fungi of 10.5%. The predominant Gram-positive isolate was coagulase-negative staphylococci. Acinetobacter baumannii, Escherichia coli and Klebsiella were the common Gram-negative strains. Compared to 2012-2015 years, the proportion of Gram-negative bacteria increased markedly during 2016-2019 years. Vancomycin, teicoplanin and linezolid were still 100% sensitive to Gram-positive bacteria. For the multidrug-resistant Gram-negative bacteria, only tigecycline was the 100% sensitive antibiotics. The mortality of the 72 patients was 30.6%. In the multivariate analysis, age >50 years, combined pulmonary infection and CSF glucose < normal value were associated with poor prognosis. Conclusions: CNS infections cause high mortality worldwide. Although Gram-positive bacteria are still the primary pathogen of CNS infections, Gram-negative bacteria had increased in recent years and should be considered in the choice of empirical antibiotic treatment. Special attention should be given to older patients and those combined pulmonary infection and with low CSF glucose level.

scholarly journals Epidemiology of patients with central nervous system infections, mainly neurosurgical patients: a retrospective study from 2012 to 2019 in a teaching hospital in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zheng Zhang ◽  
Yan Song ◽  
Jianbang Kang ◽  
Surong Duan ◽  
Qi Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Central Nervous System ◽  
Nervous System ◽  
Retrospective Study ◽  
Bacterial Infections ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Cns Infections

Abstract Background Central nervous system (CNS) infections are relatively rare but are associated with high mortality worldwide. Empirical antimicrobial therapy is crucial for the survival of patients with CNS infections, and should be based on the knowledge of the pathogen distribution and antibiotic sensitivities. The aim of this study was to investigate the features of pathogens in patients with CNS infections in North China and evaluate the risk factors for mortality and multi-drug-resistant (MDR) bacterial infections. Methods A retrospective study was conducted with patients with positive cerebrospinal fluid (CSF) cultures in a teaching hospital from January 2012 to December 2019. The following data were collected: demographic characteristics, laboratory data, causative organisms and antimicrobial sensitivity results. Data were analyzed with SPSS 16.0. Univariate analysis and binary logistic regression analyses were performed to identify the risk factors for mortality and MDR bacterial infections. Results A total of 72 patients were diagnosed with CNS infections, and 86 isolates were identified. The proportions of Gram-positive bacteria, Gram-negative bacteria and fungi were 59.3, 30.2 and 10.5%, respectively. The predominant Gram-positive bacteria was Coagulase-negative Staphylococci. Acinetobacter baumannii, Escherichia coli and Klebsiella spp. were the predominant Gram-negative bacteria. Compared to 2012–2015 years, the proportion of Gram-negative bacteria increased markedly during 2016–2019 years. Coagulase-negative Staphylococci, Streptococcus pneumoniae and Enterococcus faecium had 100% sensitivity to vancomycin, teicoplanin and linezolid. Acinetobacter baumannii and Klebsiella pneumoniae were 100% sensitive to tigecycline. Escherichia coli had 100% sensitivity to amikacin, meropenem and imipenem. The overall mortality rate in the 72 patients was 30.6%. In multivariate analysis, age > 50 years, pulmonary infections and CSF glucose level < the normal value were associated with poor outcomes. CSF adenosine deaminase level > the normal value and the presence of external ventricular drainage/lumbar cistern drainage were associated with MDR bacterial infections. Conclusions The mortality rate due to CNS infections reached 30.6% in our study. The proportion of Gram-negative bacteria has increased markedly in recent years. We should give particular attention to patients with risk factors for mortality and MDR bacterial infections mentioned above.

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