A Successful Treatment of a Patient Infected with Pan-drug Resistant Acinetobacter baumannii Ventriculitis with Intravenous Sulbactam: A Case Study

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P. Keandoungchun
P. Narischat
W. Laosuebsakhunthai
A. Ubontachart


The post neurosurgical ventriculitis caused by Acinetobacter baumannii (A. baumannii) is an important problem disorder in neurosurgical patients that can lead to serious medical complications, or even to death. This is because A. baumannii frequently can develop multi-drug resistance to several classes of antibiotic, rendering conventional treatment method ineffective. In this case study, we report a case where our patient who is infected with post neurosurgical ventriculitis from A. baumannii (pan-drug resistant strain) is successfully treated with 12 grams per day of intravenous sulbactam concurrent with usual dose of intravenous tigecycline and intraventricular colistin. This successful treatment can be another novel adjunctive therapy for the treatment of CNS infection caused by A. baumannii (pan-drug resistant) using intravenous non-colistin base plus intraventricular colistin base regimen in post neurosurgical condition.

Post neurosurgical ventriculitis, multidrug resistant, Acinetobacter baumannii, intraventricular colistin, intravenous high dose sulbactam

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Keandoungchun, P., Narischat, P., Laosuebsakhunthai, W., & Ubontachart, A. (2020). A Successful Treatment of a Patient Infected with Pan-drug Resistant Acinetobacter baumannii Ventriculitis with Intravenous Sulbactam: A Case Study. Asian Journal of Case Reports in Medicine and Health, 3(1), 13-20. Retrieved from https://journalajcrmh.com/index.php/AJCRMH/article/view/30119
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Wang M, Wei H, Zhao Y, Shang L, Di L, Lyu C, et al. Analysis of multidrug-resistant bacteria in 3223 patients with Hospital-Acquired Infections (HAI) from a tertiary general hospital in China. Bosn J of Basic Med Sci. 2019;19(1):86-93.

Kunz AN, Brook I. Emerging resistant gram-negative aerobic bacilli in hospital-acquired infections. Chemotherapy. 2010;56(6):492-500.

Dijkshoorn L, Nemec A, Seifert H. An increasing threat in hospitals: Multidrug-resistant Acinetobacter baumannii. Nat Rev Microbiol. 2007;5(12):939-51.

Quartin AA, Scerpella EG, Puttagunta S, Kett DH. A comparison of microbiology and demographics among patients with healthcare-associated, hospital acquired and ventilator-associated pneumonia: A retrospective analysis of 1184 patients from a large, international study. BMC Infectious Diseases. 2013;13: 561.

Tedja R, Nowacki A, Fraser T, Fatica C, Griffiths L, Gordon S, et al. The impact of multidrug resistance on outcomes in ventilator-associated pneumonia. Am J Infect Control. 2014;42(5): 542-5.

Chaari A, Mnif B, Bahloul M, Mahjoubi F, Chtara K, Turki O, et al. Acinetobacter baumannii ventilator-associated pneumonia: Epidemiology, clinical characteristics and prognosis factors. Int J Infect Dis. 2013;17(12):e1225-8.

Venkataraman R, Divatia JV, Ramakrishnan N, Chawla R, Amin P, Gopal P, et al. Multicenter observational study to evaluate epidemiology and resistance patterns of common intensive care unit‑infections. Indian J Crit Care Med. 2018; 22(1):20-26.

Peng S1, Lu Y. Clinical epidemiology of central venous catheter–related bloodstream infections in an intensive care unit in China. J Crit Care. 2013;28(3):277-83.

Tang CQ, Li JQ, Shou BM, Pan BH, Chen TS, Xiao YQ, et al. Epidemiology and outcomes of bloodstream infections in 177 severe burn patients from an industrial disaster: A multicentre retrospective study, Clin Microbiol Infect. 2018;24(2):199.e1-199.e7.

Gomila A, Carratalà J, Eliakim-Raz N, Shaw E, Tebé, Wolkewitz M, et al. Clinical outcomes of hospitalised patients with catheter-associated urinary tract infection in countries with a high rate of multidrug-resistance: The Combacte-Magnet Rescuing study. Antimicrob Resist Infect Control. 2019;8:198.

Shaw E, Addy I, Stoddart M, Vank C, Grier S, Wiegand I, on behalf of the Combacte-Magnet Consortium, et al. Retrospective observational study to assess the clinical management and outcomes of hospitalised patients with complicated urinary tract infection in countries with high prevalence of multidrug resistant Gram-negative bacteria (RESCUING). BMJ Open. 2016;6(7):e011500.

Lee YC, Hsiao CY, Hung MC, Hung SC, Wang HP, Huang YJ, et al. Bacteremic urinary tract infection caused by multidrug-resistant Enterobacteriaceae are associated with severe sepsis at admission: Implication for empirical therapy. Medicine (Baltimore). 2016;95 (20):e3694.

Young LS, Sabel AL, Price CS. Epidemiologic, clinical and economic evaluation of an outbreak of clonal multidrug-resistant Acinetobacter baumannii infection in a surgical intensive care unit. Infect Control Hosp Epidemiol. 2007;28(11):1247-54.

Helal S, El Anany M, Ghaith D, Rabeea S. The Role of MDR-Acinetobacter baumannii in orthopedic surgical site Infections. Surg Infect (Larchmt). 2015;16(5):518-22.

Babaei M, Sulong A, Hamat R, Nordin S, Neela V. Extremely high prevalence of antiseptic resistant quaternary ammonium compound E gene among clinical isolates of multiple drug resistant Acinetobacter baumannii in Malaysia. Ann Clin Microbiol Antimicrob. 2015;14:11.

Abat C, Fournier PE, Jimeno MT, Rolain JM, Raoult D. Extremely and pandrug-resistant bacteria extra-deaths: Myth or reality?. Eur J Clin Microbiol Infect Dis. 2018;37(9):1687-1697.

Karakonstantis S, Kritsotakis EI, Gikas A4. Pandrug-resistant Gram-negative bacteria: A systematic review of current epidemiology, prognosis and treatment options. J Antimicrob Chemother. 2020;75 (2):271-282.

Guardado AR, Blanco A, Asensi V, Pérez F, Rial JC, Pintado V, et al. Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: Assessment of different treatments. J Antimicrob Chemother. 2008; 61(4):908-13.

Sam JE, Lim CL, Sharda P, Wahab NA. The organisms and factors affecting outcomes of external ventricular drainage catheter-related ventriculitis: A penang experience. Asian J Neurosurg. 2018; 13(2):250-257.

Bargiacchi O, De Rosa FG. Intrathecal or intraventricular colistin: A review. Infez Med. 2016; 24(1):3-11.

Bargiacchi O, Rossati A, Car P, Brustia D, Brondolo R, Rosa F, et al. Intrathecal/intraventricular colistin in external ventricular device-related infections by multi-drug resistant Gram negative bacteria: case reports and review. Infection. 2014;42(5):801-9.

Michalopoulos AS, Karatza DC. Multidrug-resistant Gram-negative infections: The use of colistin. Expert Rev Anti Infect Ther. 2010;8(9):1009-17.

Dalgic N, Ceylan Y, Sancar M, Telhan L, Kafadar I, Cavusoglu H, et al. Successful treatment of multidrug-resistant Acinetobacter baumannii ventriculitis with intravenous and intraventricular colistin. Ann Trop Paediatr. 2009;29(2):141-7.

Yu Z, Pang X, Wu X, Shan C, Jiang S. Clinical outcomes of prolonged infusion (Extended infusion or continuous infusion) versus intermittent bolus of meropenem in severe infection: A meta-analysis. PLoS One. 2018;13(7):e0201667.

Kondo N, Ikawa K, Murakami Y, Uemura K, Sudo T, Hashimoto Y, et al. Clinical pharmacokinetics of meropenem in pancreatic juice and site-specific pharmacodynamic target attainment against Gram-negative bacteria: dosing considerations. Pancreatology. 2014;14 (2):95-9.

Perrott J, Mabasa VH, Ensom MH. Comparing outcomes of meropenem administration strategies based on pharmacokinetic and pharmacodynamic principles: a qualitative systematic review. Ann Pharmacother. 2010;44(3):557-64.

Karaiskos I, Galani L, Baziaka F, Giamarellou H. Intraventricular and intrathecal colistin as the last therapeutic resort for the treatment of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii ventriculitis and meningitis: A literature review. Int J Antimicrob Agents. 2013;41(6):499–508.

Al Shirawi N, Memish ZA, Cherfan A, Al Shimemeri A. Post-neurosurgical meningitis due to multidrug-resistant Acinetobacter baumanii treated with intrathecal colistin: case report and review of the literature. J Chemotherapy. 2006;18:554–558.

Benifla M, Zucker G, Cohen A, Alkan M. Successful treatment of Acinetobacter meningitis with intrathecal polymyxin E. J Antimicrob Chemother. 2004;54:290–292.

Bukhary Z, Mahmood W, Al-Khani A, Al-Abdely HM. Treatment of nosocomial meningitis due to a multi-drug resistant Acinetobacter baumannii with intraventricular colistin. Saudi Med J. 2005; 26(4):656-8.

Ho YH, Wang LS, Chao HJ, Chang KC, Su CF. Successful treatment of meningitis caused by multidrug-resistant Acinetobacter baumannii with intravenous and intrathecal colistin. J Microbiol Immunol Infect. 2007;40(6):537-40.

Chusri S, Sakarunchai I, Kositpantawong N, Panthuwong S, Santimaleeworagun W, Pattharachayakul S, et al. Outcomes of adjunctive therapy with intrathecal or intraventricular administration of colistin for post-neurosurgical meningitis and ventriculitis due to carbapenem-resistant Acinetobacter baumannii. Int J Antimicrob Agents. 2018;51(4):646-650.

Saelim W, Santimaleeworagun W, Thunyaharn S, Changpradub D, Juntanawiwat P. Pharmacodynamic profiling of optimal sulbactam regimens against carbapenem-resistant Acinetobacter baumannii for critically ill patients. Asian Pac J Trop Biomed. 2018; 8:14-8.

Jaruratanasirikul S, Wongpoowarak W, Wattanavijitkul T, Sukarnjanaset W, Samaeng M, Nawakitrangsan M, et al. Population pharmacokinetics and pharmacodynamics modeling to optimize dosage regimens of sulbactam in critically ill patients with severe sepsis caused by Acinetobacter baumannii. Antimicrob Agents Chemother. 2016;60(12):7236-7244.

Foulds G, McBride TJ, Knirsch AK, Rodriguez WJ, Khan WN. Penetration of sulbactam and ampicillin into cerebrospinal fluid of infants and young children with meningitis. Antimicrob Agents Chemother. 1987;31(11):1703-5.

Kuo HY, Wang FD, Yen YF, Lin ML, Liu CY. In vitro activities of piperacillin or cefoperazone alone and in combination with β-lactamase inhibitors against gram-negative bacilli. New Microbiol. 2009;32(1):49-55.

Kuah BG, Kumarasinghe G, Doran J, Chang HR. Antimicrobial susceptibilities of clinical isolates of Acinetobacter baumannii from Singapore. Antimicrob Agents Chemother. 1994;38:2502–3.

Dueñas Díez AI, Bratos Pérez MA, Eiros Bouza JM, Almaraz Gómez A, Gutiérrez Rodríguez P, Miguel Gómez MA, et al. Susceptibility of the Acinetobacter calcoaceticus A. baumannii complex to imipenem, meropenem, sulbactam and colistin. Int J Antimicrob Agents. 2004;23:487–93.