Division of Infectious Diseases and Infection Control, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand.
Clin Microbiol Infect. 2010 Jul;16(7):888-94. doi: 10.1111/j.1469-0691.2009.03019.x. Epub 2009 Aug 17.
Treatment limitations exist for drug-resistant Acinetobacter baumannii central nervous system (CNS) infection. We conducted a retrospective study and systematic literature review to identify patients with drug-resistant A. baumannii CNS infection who received primary or adjunct intrathecal or intraventricular (IT/IVT) colistin. In a case series of seven Thai patients and 17 patients identified in the literature, clinical and microbiological cure rates with IT/IVT colistin therapy were 83% and 92%, respectively. Three patients (13%) developed chemical ventriculitis and one (4%) experienced treatment-associated seizures. Death was associated with delayed IT/IVT colistin therapy compared to survival (mean time from diagnosis to IT/IVT colistin, 7 vs. 2 days; p 0.01). The only independent predictor of mortality was the severity of illness (APACHE II score > 19, adjusted odds ratio 49.5; 95% CI 1.7-1428.6; p 0.02). This case series suggests that administration of primary or adjunctive IT/IVT colistin therapy was effective for drug-resistant A. baumannii CNS infection.
治疗耐药鲍曼不动杆菌中枢神经系统（CNS）感染存在局限性。我们进行了一项回顾性研究和系统文献回顾，以确定接受原发性或辅助性鞘内或脑室内（IT/IVT）黏菌素治疗的耐药鲍曼不动杆菌 CNS 感染患者。在一个由七名泰国患者和文献中确定的 17 名患者组成的病例系列中，IT/IVT 黏菌素治疗的临床和微生物治愈率分别为 83%和 92%。三名患者（13%）发生化学性脑室炎，一名患者（4%）出现与治疗相关的癫痫发作。与存活相比，延迟 IT/IVT 黏菌素治疗与死亡相关（从诊断到 IT/IVT 黏菌素的平均时间，7 天与 2 天；p 0.01）。死亡的唯一独立预测因素是疾病严重程度（APACHE II 评分>19，调整后的优势比 49.5；95%CI 1.7-1428.6；p 0.02）。该病例系列表明，原发性或辅助性 IT/IVT 黏菌素治疗对耐药鲍曼不动杆菌 CNS 感染有效。
