Tafelski Sascha, Wagner Lukas, Angermair Stefan, Deja Maria
Charité Virchow Klinikum and Campus Mitte, Berlin, Germany.
Charité Benjamin Franklin, Berlin, Germany.
SAGE Open Med Case Rep. 2017 Jun 19;5:2050313X17711630. doi: 10.1177/2050313X17711630. eCollection 2017.
Intracranial infections due to multidrug- resistant (MDR) gram-negative pathogens are associated with increased morbidity and mortality. As therapeutic options are limited and systemic drug penetration into the infection focus is difficult, intraventricular therapy has been described.
We report on a patient with intracranial abscess caused by MDR Acinetobacter baumannii.
He was treated with high doses of intravenous and intraventricular colistin resulting in microbiological clearance and clinical cure. Therapy was controlled by therapeutic drug monitoring (TDM) of serum and liquor colistin levels. About 100 cases with intraventricular or intrathecal colistin are reported in literature but data on TDM are sparse.
This is one of the first cases providing data on TDM for locally administered high dose colistin therapy for the treatment of intracranial abscess formations. Based on these findings, increasing the intraventricular application interval paralleled with intravenous colistin could possibly be sufficient to achieve appropriate therapeutic drug levels. Further studies are needed to support alternative dosing strategies in similar cases.
耐多药（MDR）革兰氏阴性病原体引起的颅内感染与发病率和死亡率增加相关。由于治疗选择有限且全身药物难以渗透到感染灶，因此已有脑室内治疗的报道。
我们报告了1例由耐多药鲍曼不动杆菌引起的颅内脓肿患者。
患者接受了高剂量静脉及脑室内多黏菌素治疗，实现了微生物清除和临床治愈。通过血清和脑脊液多黏菌素水平的治疗药物监测（TDM）来控制治疗。文献报道了约100例脑室内或鞘内使用多黏菌素的病例，但关于TDM的数据较少。
这是首批提供高剂量局部应用多黏菌素治疗颅内脓肿形成的TDM数据的病例之一。基于这些发现，延长脑室内给药间隔并同时静脉应用多黏菌素可能足以达到适当的治疗药物水平。需要进一步研究以支持类似病例的替代给药策略。
