Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters:: assessment of different treatments
Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters:: assessment of different treatments
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DOI：
10.1093/jac/dkn018
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发表时间：
2008-04-01
影响因子：
5.2
通讯作者：
Carton, J. A.
中科院分区：
文献类型：
--
作者：
Guardado, A. Rodriguez;Blanco, A.;Carton, J. A.
背景资料：多重耐药鲍曼不动杆菌脑膜炎的治疗是一个严重的治疗问题，由于有限的抗生素渗透到CSF。我们描述的临床特点和结果的一组患者与医院获得性神经外科脑膜炎治疗不同的治疗选择。结果：1990 ~ 2004年共发生鲍曼不动杆菌医院感染51例。27例患者接受静脉（iv）单药治疗：碳青霉烯类（21例），氨苄西林/舒巴坦（4例）和其他抗生素（2例）。4例患者接受静脉联合治疗。19例患者接受静脉注射和鞘内注射治疗：8例同时接受粘菌素静脉注射和鞘内注射，4例同时接受碳青霉烯类抗生素静脉注射和鞘内注射或仅鞘内注射氨基糖苷类抗生素（5例），2例接受其他治疗。17名患者因感染死亡。1例患者未经治疗死亡。平均（SD）治疗持续时间为17.4（8.3）天（范围3-44）。虽然没有患者接受粘菌素治疗死亡，我们没有观察到统计学上的差异，死亡率与不同treatment.Conclusions组：院内不动杆菌脑膜炎有很高的死亡率。静脉注射和鞘内注射粘菌素是治疗医院获得性不动杆菌脑膜炎的有效和安全的选择。
Background: The treatment of multidrug-resistant Acinetobacter baumannii meningitis is a serious therapeutic problem due to the limited penetration of antibiotics into the CSF. We describe the clinical features and the outcome of a group of patients with nosocomial neurosurgical meningitis treated with different therapeutic options.Methods: All patients with nosocomial post-surgical meningitis due to A. baumannii diagnosed between 1990 and 2004 were retrospectively reviewed.Results: During the period of study, 51 cases of this nosocomial infection were identified. Twenty-seven patients were treated with intravenous (iv) monotherapy: carbapenems (21 cases), ampicillin/sulbactam (4 cases) and other antibiotics (2 cases). Four patients were treated with iv combination therapy. Nineteen patients were treated with iv and intrathecal regimens: colistin by both routes (8 cases), carbapenems plus iv and intrathecal (4 cases) or only intrathecal (5 cases) aminoglycosides, and others (2 cases). Seventeen patients died due to the infection. One patient died without treatment. The mean (SD) duration of therapy was 17.4 (8.3) days (range 3-44). Although no patients treated with colistin died, we did not observe statistically significant differences in the mortality among the groups with different treatments.Conclusions: Nosocomial Acinetobacter meningitis has a high mortality. Combined therapy with iv and intrathecal colistin is a useful and safe option in the treatment of nosocomial Acinetobacter meningitis.