Gump William C, Walsh John W
Department of Neurological Surgery, Tulane University Medical Center, New Orleans, Louisiana, USA.
J Neurosurg. 2005 May;102(5):915-7. doi: 10.3171/jns.2005.102.5.0915.
Nosocomial infections with organisms resistant to multiple antibiotic agents represent an evolving challenge in the intensive care setting, particularly in patients requiring surgical diversion of cerebrospinal fluid. The authors present the case of a 51-year-old woman who endured protracted hospitalization and required multiple surgeries including placement of a ventriculoperitoneal shunt. The shunt subsequently became colonized with Pseudomonas aeruginosa, which demonstrated intermediate sensitivity to amikacin and full resistance to all other antibiotics tested 'After failing to respond to intravenous imipenem as well as intravenous and intrathecal amikacin, the patient was successfully treated with intravenous and intrathecal colistin. Colistin is a polymyxin-type antibiotic, rarely used outside of topical application because of reported nephrotoxicity associated with parenteral administration. With activity limited to Gram-negative organisms, colistin is bactericidal by directly disrupting the structure of cell membranes. Authors of a few case reports in the literature have described successful treatment of various ventriculitis with the intrathecal administration of colistin. With bacterial resistances outpacing the pharmaceutical industry's ability to develop novel antibiotics, colistin represents an important alternative in situations involving multidrug-resistant organisms.
医院内感染多重耐药菌在重症监护环境中是一个不断演变的挑战，尤其是在需要进行脑脊液外科分流的患者中。作者介绍了一名51岁女性的病例，她经历了长时间住院，并需要多次手术，包括放置脑室腹腔分流管。分流管随后被铜绿假单胞菌定植，该菌对阿米卡星表现出中度敏感性，对所有其他测试抗生素均完全耐药。在对静脉注射亚胺培南以及静脉和鞘内注射阿米卡星均无反应后，患者成功接受了静脉和鞘内注射黏菌素治疗。黏菌素是一种多粘菌素类抗生素，由于据报道与肠外给药相关的肾毒性，很少在局部应用之外使用。黏菌素的活性仅限于革兰氏阴性菌，通过直接破坏细胞膜结构而具有杀菌作用。文献中的一些病例报告作者描述了鞘内注射黏菌素成功治疗各种脑室炎的情况。随着细菌耐药性超过制药行业开发新型抗生素的能力，黏菌素在涉及多重耐药菌的情况下是一种重要的替代药物。
