Carbapenem-resistant Acinetobacter baumannii septicemia and meningitis in a neonate treated with colistin and netilmycin

Abstract

A term, male infant with a large frontoethmoidal encephalomeningocele underwent a cranial defect repair with excision of nasoencephalocele after the mass had ruptured. Two days after operation, the wound became infected and the infant developed sepsis and meningitis due to carbapenem-resistant Acinetobacter baumannii. Ultrasonographic study of the brain revealed severe obstructive hydrocephalus and evidence of ventriculitis. He was treated with intravenous netilmycin, ampicillin/sulbactam and oral rifampicin. Four days later, the blood and cerebrospinal fluid cultures grew no organism but the infant still had persistent thrombocytopenia with evidence of disseminated intravascular coagulation, so colistin 5 mg/kg/day given intravenously every 8 hr was added. His condition gradually improved. He was treated with intravenous amphotericin B concomitantly due to nosocomial fungal infection. Colistin was given for 6 weeks; netilmycin, ampicillin/sulbactam and rifampicin were given for 4 weeks. There was no rising of serum creatinine even though he also received other nephrotoxic agents. Intravenous colistin in combination with netilmycin and rifampicin may be a potentially effective and safe therapy for meningitis caused by carbapenem-resistant A. baumannii in infant.