Variables determining mortality in patients with Acinetobacter baumannii meningitis/ventriculitis treated with intrathecal colistin

Clin Neurol Neurosurg. 2017 Feb;153:43-49. doi: 10.1016/j.clineuro.2016.12.006. Epub 2016 Dec 14.

Abstract

Aim: To examine the variables associated with mortality in patients with Acinetobacter baumannii-related central nervous system infections treated with intrathecal colistin.

Materials and methods: This multi-centre retrospective case control study included patients from 11 centres in Turkey, as well as cases found during a literature review. Only patients with CNS infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii treated with intrathecal colistin were included in this study. The variables associated with mortality were determined by dividing the patients into groups who died or survived during hospitalisation, and who died or survived from Acinetobacter meningitis.

Results: Among the 77 cases enrolled in the study, 35 were found through a literature review and 42 were cases from our centres. Forty-four cases (57.1%) were male and the median age was 48 years (range: 20-78 years). Thirty-seven patients (48%) died during hospitalisation. The variables associated with increased all-cause mortality during hospitalisation included old age (odds ratio, 1.035; 95% confidence interval (CI), 1.004-1.067; p=0.026) and failure to provide cerebrospinal fluid sterilisation (odds ratio, 0.264; 95% confidence interval, 0.097-0.724; p=0.01). There is a trend (P=0.062) towards higher mortality with using of meropenem during meningitis treatment. Fifteen cases (19%) died from meningitis. There were no significant predictors of meningitis-related mortality.

Conclusions: The mortality rate for central nervous system infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii is high. Old age and failure to provide CSF sterilisation are associated with increased mortality during hospitalisation.

Keywords: Acinetobacter baumannii; Colistin; Intratechal; Meningitis.

Publication types

  • Multicenter Study

MeSH terms

  • Acinetobacter Infections / epidemiology
  • Acinetobacter Infections / mortality*
  • Acinetobacter baumannii / pathogenicity*
  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / pharmacology*
  • Case-Control Studies
  • Cerebral Ventriculitis / epidemiology
  • Cerebral Ventriculitis / mortality*
  • Colistin / administration & dosage
  • Colistin / pharmacology*
  • Female
  • Humans
  • Injections, Spinal
  • Male
  • Meningitis, Bacterial / epidemiology
  • Meningitis, Bacterial / mortality*
  • Meropenem
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Retrospective Studies
  • Thienamycins / administration & dosage
  • Thienamycins / pharmacology*
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Thienamycins
  • Meropenem
  • Colistin