Evaluation of intraventricular colistin utilization: A case series

Purpose: Multi-drug resistant organisms (MDROs) are an increasing concern in health systems. Pathogens such as Pseudomonas aeruginosa, Acinetobacter baumanii, and carbapenamase-producing Enterobacteriaceae hold highest mortality rates especially when the central nervous system is involved. When MDROs are cultured treatment options are limited and reliance on medications such as colistin is becoming more prevalent. Penetration of these therapies into the central nervous system is concerning therefore local administration is a potential concomitant therapy. Methods: This study was a retrospective review from 2009 to 2015 for all patients with documented MDROs gram negative pathogens who received intraventricular colistin. Results: Seven patients met inclusion criteria. The average age of the patients was 49 years old, 4 were males, and the median length of intensive care unit stay was 30 days. The duration of therapy ranged from 2 to 14 days and all cerebrospinal fluid cultures were sterile at 7 days after administration of colistin. Six of the seven patients were discharged from the hospital and one discharged to a skilled nursing facility. The use of intraventricular colistin was not associated with any reported adverse events. Conclusion: The use of intraventricular colistin was associated with positive clinical outcomes with no reported adverse effects. (C) 2017 Elsevier Inc. All rights reserved.