Department of Pediatric Medicine, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng District, Hangzhou, 310015, China.
Department of Pediatric Intensive Care Unit, The Children's Hospital, Zhejiang University School of Medicine, 3333 Bingsheng Road, Hangzhou, 310003, China.
Infection. 2019 Aug;47(4):643-649. doi: 10.1007/s15010-018-1234-1. Epub 2018 Oct 16.
The incidence of Acinetobacter baumannii meningitis, which typically occurs after neurosurgery, has increased in recent years. Pediatric Acinetobacter baumannii meningitis due to the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains has important clinical significance.
We retrospectively reviewed the clinical course and outcome of nine cases of meningitis due to Acinetobacter baumannii in children and reviewed the relevant literature.
Seven patients had a history of neurosurgery, and the average time from the first surgery to cerebrospinal fluid (CSF) culture in these seven patients was 23.71 ± 17.43 days. Of all nine patients, four patients showed MDR isolates, two showed XDR isolates, and one showed pan-drug-resistant (PDR) isolates. Three patients received an intrathecal injection of amikacin. Two patients received intravenous colistin (5 mg/kg), and one received polymyxin B (2 mg/kg). The mean hospitalization duration was 39.44 days. Four patients eventually died: two with MDR Acinetobacter, one with PDR Acinetobacter, and one with susceptible Acinetobacter. Two of them still had positive CSF cultures at death.
Acinetobacter baumannii meningitis is usually associated with neurosurgery and the placement of foreign material, and it usually has a high mortality. Intrathecal or intraventricular polymyxin administration is expected to be an effective choice for meningitis but requires further study.
近年来，神经外科术后发生的鲍曼不动杆菌脑膜炎的发病率有所增加。由于出现了耐多药（MDR）和广泛耐药（XDR）菌株，儿科鲍曼不动杆菌脑膜炎具有重要的临床意义。
我们回顾性分析了 9 例儿童鲍曼不动杆菌脑膜炎的临床经过和转归，并复习了相关文献。
7 例患者有神经外科手术史，这 7 例患者从首次手术到脑脊液（CSF）培养的平均时间为 23.71±17.43 天。在所有 9 例患者中，4 例分离出 MDR 菌株，2 例分离出 XDR 菌株，1 例分离出全耐药（PDR）菌株。3 例患者接受了阿米卡星鞘内注射。2 例患者接受了静脉注射黏菌素（5mg/kg），1 例患者接受了多黏菌素 B（2mg/kg）。平均住院时间为 39.44 天。最终有 4 例患者死亡：2 例为 MDR 鲍曼不动杆菌，1 例为 PDR 鲍曼不动杆菌，1 例为敏感鲍曼不动杆菌。其中 2 例在死亡时仍有阳性 CSF 培养。
鲍曼不动杆菌脑膜炎通常与神经外科手术和异物植入有关，死亡率通常较高。鞘内或脑室注射黏菌素有望成为治疗脑膜炎的有效选择，但需要进一步研究。
