Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain.
Acta Neurochir (Wien). 2009 Nov;151(11):1465-72. doi: 10.1007/s00701-009-0382-6. Epub 2009 May 8.
Acinetobacter baumannii has emerged as an important nosocomial pathogen that can cause a multitude of severe infections. In neurosurgical patients the usual presentation is ventriculitis associated with external ventricular drainage. Carbapenems have been considered the gold standard for the treatment of Acinetobacter baumannii ventriculitis, but resistant isolates are increasing worldwide, reducing the therapeutic options. In many cases polymyxins are the only possible alternative, but their poor blood-brain barrier penetration could require them to be directly administered intraventricularly and clinical experience with this route is limited. We review the literature concerning intraventricular use of colistin (polymyxin E) for A. baumannii ventriculitis and add three cases successfully treated with this method. Our experience suggests that intraventricular colistin is a potentially effective and safe therapy for the treatment of multidrug-resistant A. baumannii central nervous system infections.
鲍曼不动杆菌已成为一种重要的医院获得性病原体，可引起多种严重感染。在神经外科患者中，其常见表现为与外部脑室引流相关的脑室炎。碳青霉烯类药物被认为是治疗鲍曼不动杆菌脑室炎的金标准，但耐药分离株在全球范围内不断增加，这降低了治疗选择。在许多情况下，多黏菌素类药物是唯一可能的选择，但它们在血脑屏障中的穿透性较差，可能需要直接脑室内给药，而这种途径的临床经验有限。我们复习了关于多黏菌素 E（黏菌素）治疗鲍曼不动杆菌脑室炎的文献，并增加了三例成功应用该方法治疗的病例。我们的经验表明，脑室内黏菌素可能是一种治疗多重耐药鲍曼不动杆菌中枢神经系统感染的有效且安全的方法。
