Intrathecal colistin for drug-resistant Acinetobacter baumannii central nervous system infection: a case series and systematic review
Intrathecal colistin for drug-resistant Acinetobacter baumannii central nervous system infection: a case series and systematic review
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DOI：
10.1111/j.1469-0691.2009.03019.x
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发表时间：
2010-07-01
影响因子：
14.2
通讯作者：
Mundy, L. M.
中科院分区：
文献类型：
--
作者：
Khawcharoenporn, T.;Apisarnthanarak, A.;Mundy, L. M.
耐药鲍曼不动杆菌中枢神经系统（CNS）感染的治疗存在局限性.我们进行了一项回顾性研究和系统的文献回顾，以确定耐药A。接受原发性或辅助鞘内或脑室内（IT/IVT）粘菌素治疗的鲍曼不动杆菌CNS感染患者。在文献中确定的7例泰国患者和17例患者的病例系列中，IT/IVT粘菌素治疗的临床和微生物治愈率分别为83%和92%。3例患者（13%）发生化学性脑室炎，1例（4%）发生治疗相关癫痫发作。与生存期相比，死亡与IT/IVT粘菌素治疗延迟相关（从诊断到IT/IVT粘菌素治疗的平均时间，7天vs. 2天; p <0.01）。死亡率的唯一独立预测因素是疾病的严重程度（APACHE II评分> 19，校正比值比49.5; 95% CI 1.7-1428.6; p 0.02）。该病例系列表明，原发性或连续性IT/IVT粘菌素治疗对耐药A有效。鲍曼不动杆菌CNS感染。
P>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.