Sayin Kutlu Selda, Saçar Suzan, Süzer Tuncer, Cevahir Nural, Okke Demet, Dirgen Caylak Selmin, Turgut Hüseyin
Pamukkale Universitesi Tip Fakültesi, Infeksiyon Hastaliklari ve Klinik Mikrobiyoloji Anabilim Dali, Denizli.
Mikrobiyol Bul. 2008 Apr;42(2):353-8.
Acinetobacter baumannii is an important pathogen which causes severe nosocomial infections such as meningitis. Multidrug resistance is a growing problem throughout the world. In this report a case of multidrug resistant A.baumannii meningitis, treated with high dose of ampicillin-sulbactam (SAM) was presented. Rhinorrhea and confusion developed on the postoperative seventh day in a 67 years old male patient operated for macroadenoma of the hyphophysis gland. Since the cerebrospinal fluid (CSF) findings indicated a central nervous system infection, nosocomial meningitis was diagnosed and intravenous ceftazidime and vancomycin have started. Blood and CSF cultures of the patient revealed no growth and his general condition has improved. However, fever and confusion emerged again on the 21st day of therapy and the repeat CSF sample revealed increased pressure, purulent appearance, 510/mm3 leukocytes (90% PMNL), 58 mg/dl glucose (simultaneous blood glucose was 144 mg/dl) and 49 mg/dl protein. Direct microscopic examination of CSF revealed gram-negative coccobacilli and A.baumannii was identified in the culture. The isolate was resistant to piperacillin-tazobactam, third generation cephalosporins, aztreonam, ciprofloxacin, carbapenems and aminoglycosides, susceptible to sulbactam ampicillin and colistin. Ampicillin (12 gr) and sulbactam (6 gr) treatment was initiated and at the 72nd hour of the therapy the temperature and conciousness level of the patient returned to normal. Control CSF sample obtained on the 14th day of treatment revealed no leukocytes and no bacterial growth. The treatment was continued for 21 days and the patient recovered without any sequela. Since colistin which is one of the alternative antimicrobial treatment choices for resistant Acinetobacter infections, is not found in Turkey, sulbactam-ampicillin might be an effective and safe choice for the treatment of multi-resistant A. baumannii meningitis if the isolate was proven to be susceptible by antibiotic susceptibility tests.
鲍曼不动杆菌是一种重要的病原体，可引起严重的医院感染，如脑膜炎。多重耐药性在全球范围内日益严重。本报告介绍了一例用大剂量氨苄西林-舒巴坦（SAM）治疗的多重耐药鲍曼不动杆菌脑膜炎病例。一名67岁男性患者因垂体大腺瘤接受手术，术后第7天出现鼻漏和意识模糊。由于脑脊液（CSF）检查结果提示中枢神经系统感染，诊断为医院获得性脑膜炎，并开始静脉注射头孢他啶和万古霉素。患者的血液和脑脊液培养均未发现细菌生长，其一般状况有所改善。然而，治疗第21天发热和意识模糊再次出现，再次采集的脑脊液样本显示压力升高、外观脓性、白细胞510/mm³（90%为多形核白细胞）、葡萄糖58mg/dl（同时血糖为144mg/dl）、蛋白质49mg/dl。脑脊液直接显微镜检查发现革兰氏阴性球杆菌，培养鉴定为鲍曼不动杆菌。该分离株对哌拉西林-他唑巴坦、第三代头孢菌素、氨曲南、环丙沙星、碳青霉烯类和氨基糖苷类耐药，对舒巴坦氨苄西林和黏菌素敏感。开始用氨苄西林（12g）和舒巴坦（6g）治疗，治疗72小时后患者体温和意识水平恢复正常。治疗第14天采集的对照脑脊液样本未发现白细胞和细菌生长。治疗持续21天，患者康复，无任何后遗症。由于土耳其没有作为耐药不动杆菌感染替代抗菌治疗选择之一的黏菌素，如果通过药敏试验证明分离株敏感，舒巴坦-氨苄西林可能是治疗多重耐药鲍曼不动杆菌脑膜炎的有效且安全的选择。
