Saleem Ali Faisal, Shah Muhammad Shafaat, Shaikh Abdul Sattar, Mir Fatima, Zaidi Anita K M
The Aga Khan University Hospital, Karachi, Pakistan.
J Infect Dev Ctries. 2011 Nov 15;5(11):809-14. doi: 10.3855/jidc.1697.
Multidrug-resistant strains of Acinetobacter pose a serious therapeutic dilemma in hospital practice, particularly when they cause meningitis, as the few antimicrobial agents to which these isolates are susceptible have poor central nervous system (CNS) penetration.
We retrospectively reviewed the clinical course and outcome of eight consecutive cases of meningitis due to Acinetobacter spp. in children ages 15 years or less, seen in a tertiary care medical center in Karachi, Pakistan.
Of the eight cases of Acinetobacter meningitis, isolates from five patients were pan-resistant, and two were multidrug-resistant. A neurosurgical procedure was performed in five of eight patients followed by external ventricular drain insertion prior to the development of infection. Seven received intravenous (IV) polymyxin (mean; 12.8 days), while 5/8 also received intrathecal (IT) polymyxin (mean; 12.0 days). The mean length of hospitalization was 38.7 ± 19 days. All patients achieved cerebrospinal fluid (CSF) culture negativity by the end of treatment (mean; 5.4 days). Two patients died: one with pan-resistant Acinetobacter, and the second with a multi-drug resistant isolate.
Post-neurosurgical multidrug-resistant and pan-resistant Acinetobacter meningitis can be successfully treated if appropriate antimicrobial therapy is instituted early. The role of IT polymyxin B administration alone versus combination therapy (IV and IT) needs further study.
不动杆菌的多重耐药菌株在医院临床实践中造成了严重的治疗困境，尤其是当它们引起脑膜炎时，因为这些分离株仅对少数几种抗菌药物敏感，而这些药物的中枢神经系统（CNS）渗透性较差。
我们回顾性分析了在巴基斯坦卡拉奇一家三级医疗中心就诊的15岁及以下儿童中连续8例不动杆菌属脑膜炎的临床病程和结局。
在8例不动杆菌脑膜炎病例中，5例患者的分离株为泛耐药，2例为多重耐药。8例患者中有5例接受了神经外科手术，在感染发生前进行了外部脑室引流插入。7例接受静脉注射（IV）多粘菌素（平均；12.8天），而8例中有5例也接受了鞘内（IT）多粘菌素（平均；12.0天）。平均住院时间为38.7±19天。所有患者在治疗结束时（平均；5.4天）脑脊液（CSF）培养均转为阴性。2例患者死亡：1例死于泛耐药不动杆菌，另1例死于多重耐药分离株。
如果早期给予适当的抗菌治疗，神经外科手术后的多重耐药和泛耐药不动杆菌脑膜炎可以成功治疗。单独鞘内注射多粘菌素B与联合治疗（静脉注射和鞘内注射）的作用需要进一步研究。
