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A Successful Application of Intraventricular and Intravenous Colistin for Extensively Drug-Resistant Acinetobacter baumannii Ventriculitis in a Neurosurgical Patient Undergoing Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome

Lapinskienė, Indrė, MD*; Linkaitė, Gabrielė, MD*†; Remeikaitė, Donata, MD*; Balčiūnas, Lukas, MD*; Kvaščevičius, Robertas, MD; Kšanas, Ugnius, MD; Šipylaitė, Jūratė, MD, PhD*†; Šerpytis, Mindaugas, MD*†

Infectious Diseases in Clinical Practice: May 2019 - Volume 27 - Issue 3 - p 178–180
doi: 10.1097/IPC.0000000000000731
Case Reports

The prevalence of extensively drug-resistant Acinetobacter baumannii neuroinfection has markedly increased, and this infection is now a first-line medical emergency worldwide with a mortality rate of up to 50%. Its expanding resistance to most intravenous antibiotic treatments, as well as the severity of the initiated condition, obligates practitioners to concentrate on today's most effective therapy—the combination of intravenous and intraventricular/intrathecal colistin. The specific characteristics of the intraventricular/intrathecal route are promising for patients with supportive mechanical devices, such as extracorporeal membrane oxygenation or hemodiafiltration, which have significant impacts on drug pharmacokinetics in the blood. This influence is minimized when antibiotics are administered directly into cerebrospinal fluid. The case report represents a history of a 39-year-old man with nosocomial carbapenem-resistant A. baumannii ventriculitis and acute respiratory distress syndrome. His treatment with intravenous and intraventricular colistin, as well as extracorporeal membrane oxygenation therapy, managed to succeed in helping the patient's recovery.

From the *Department of Intensive Care, Santaros Clinics;

Vilnius University, Lithuania; and

Department of Neurosurgery, Santaros Clinics, Vilnius, Lithuania.

Correspondence to: Gabrielė Linkaitė, MD, Department of Intensive care, Santaros Clinics, Vilnius University, Santariškių Street 2, 08661 Vilnius, Lithuania. E-mail:

The authors have no funding or conflicts of interest to disclose.

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