Treatment of severe ventriculitis caused by extensively drug-resistant Acinetobacter baumannii by intraventricular lavage and administration of colistin

Background: Severe ventriculitis (SV) caused by multidrug-resistant bacteria is associated with high morbidity and mortality in neurosurgical patients. This study assessed the outcomes of patients with SV caused by Acinetobacter baumannii who were treated by intraventricular (IVT) lavage and colistin administration. Methods: This retrospective study included consecutive patients with SV caused by A. baumannii who were admitted at the Neurosurgical Department of Shanghai Tenth Peoples Hospital from January 2014 to September 2017. Patients medical records, radiographic images, and surgical notes were reviewed. The patients were followed up for at least 6 months after discharge. Results: A total of 25 patients, including 20 male and five female, were enrolled in this study; the average age was 45.6 years. All patients underwent neurosurgery before infection, and all A. baumannii cultures from cerebrospinal fluid (CSF) showed extensive resistance to the tested antibiotics except for tigecycline and colistin. All the patients underwent IVT lavage followed by daily administration of colistin after surgery; 24 patients received a daily colistin dose of 100,000 IU, while one received 50,000 IU. The patients also received tigecycline-based systemic antibiotic treatment. The mean duration of IVT colistin was 13.4 +/- 2.8 days. The time required to obtain a negative CSF culture was 8.9 +/- 4.0 days. Of the 20 patients who were cured, eight underwent shunt surgery due to hydrocephalus before they were discharged to a rehabilitation center. Five patients died, including one who was re-admitted due to recurrence 1 month after discharge. Conclusions: IVT lavage and colistin treatment may be an effective treatment for SV caused by extensively drug-resistant A. baumannii. Future studies with a larger sample size may be needed to verify the findings in this study.