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Prolonged triple therapy for persistent multidrug-resistant Acinetobacter baumannii ventriculitis.

Prolonged triple therapy for persistent multidrug-resistant Acinetobacter baumannii ventriculitis.

Authors :
Patel, Jean A.
Pacheco, Susan M.
Postelnick, Michael
Sutton, Sarah
Source :
American Journal of Health-System Pharmacy. 8/15/2011, Vol. 68 Issue 16, p1527-1531. 5p. 1 Chart.
Publication Year :
2011

Abstract

Purpose. A case of persistent multidrug-resistant (MDR) Acinetobacter baumannii ventriculitis successfully treated with a prolonged and novel combination of antimicrobials is reported. Summary. A 38-year-old, 84-kg Caucasian woman with a recent history of craniotomy was admitted with nausea, fever, headache, photophobia, and drainage from her craniotomy incision. She underwent a repeat craniotomy on hospital day 4 with abscess debridement and repair of a cerebrospinal fluid leak. Cultures grew MDR A. baumannii, coagulase-negative Staphylococcus species, and methicillin-resistant Staphylococcus aureus. Based on the limited published pharmacokinetic and pharmacodynamic data for colistin, we determined a favorable outcome with i.v. colistin monotherapy was unlikely and decided to treat the patient with simultaneous i.v. and intraventricular colistin, as well as intraventricular tobramycin and i.v. rifampin. She was treated with a total of 36 days of intraventricular colistin, 40 days of intraventricular tobramycin, 51 days of i.v. colistin and rifampin, and 56 days i.v. vancomycin for infection that persisted despite multiple debridements. The patient had subsequent improvement in clinical manifestations and eradication of infection. She was subsequently discharged to an acute rehabilitation facility on hospital day 77 with posttreatment sequelae including mental impairment and renal failure requiring hemodialysis. Follow-up visits revealed significant improvement in her mental status, speech, and strength on the side not affected by the stroke. Conclusion. Prolonged combination therapy with intraventricular colistin and tobramycin plus i.v. colistin, rifampin, and vancomycin led to the resolution of a persistent central nervous system infection caused by MDR A. baumannii. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
10792082
Volume :
68
Issue :
16
Database :
Academic Search Index
Journal :
American Journal of Health-System Pharmacy
Publication Type :
Academic Journal
Accession number :
64451896
Full Text :
https://doi.org/10.2146/ajhp100234