Our experience with multi-drug resistant acinetobacter meningitis

Introduction: Acinetobacter baumannii (AB) meningitis is not uncommon in neurosurgical ICU and its incidence has been rising. Recent trends show that an increasing number of infections are caused by strains that are resistant to multiple drugs including carbapenems. Effective therapy in such cases is not well established and such patients often have high mortality rates. The present study shares our experience with this notorious pathogen. Case Summary: We retrospectively reviewed cases of multi-drug-resistant (MDR) AB meningitis in Fortis hospital, Mohali from January 2014 to October 2016. We identified six cases in our retrospective review of records with equal distribution in both genders. Four patients had severe craniofacial trauma with base of skull base fractures while two had neurosurgical intervention. The mean duration of ICU stay and duration of therapy was 50 days and 24 days respectively. All the patients received intrathecal/intraventricular and intravenous colistin in combination with carbpenems. One patient developed resistance to colistin while on treatment and required addition of minocycline and rifampicin to therapy. The same patient developed chemical meningitis secondary to the treatment. All six patients survived. One of them is severely disabled (modified Rankin score MRS = 5), while 3 patients had MRS 1 while 2 had a MRS of 2. Conclusion: Despite recent reports suggesting high mortality following AB meningitis, better outcomes were observed in our cohort of patients. Intraventricular/intrathecal colistin along with intravenous colistin can be an effective therapy for this dreaded disease.