Abstract
Central nervous system (CNS) infections constitute a life-threatening condition, especially in children. Treatment limitations exist for drug-resistant CNS bacterial infections. Inadequate CNS penetration and intravenous (IV) antibiotic treatment failure represent a major clinical challenge. However, patients with antibiotic-resistant bacterial CNS infections may benefit from intrathecal (IT) or intraventricular (IVT) colistin. The authors aimed to assess the safety and effectiveness of IT/IVT colistin therapy in the pediatric population, with or without other antibiotics, for the treatment of antibiotic-resistant CNS infections. A comprehensive literature search was conducted using the electronic databases of PubMed, Ovid, and Embase for relevant articles using the following terms: “Colistin”, “CNS infection”, and “Outcome”, as well as their combinations. The retrieved articles were filtered by age (Child), language (English), route of administration (IT/IVT), and species (Humans). The present systematic review comprised 20 articles that included 31 children (19; 61.2% were boys) with multidrug-resistant CNS infection. Their ages ranged from less than one month to 18 years (median: 9 months). Acinetobacter baumannii was the main causative organism in 22 patients (70.9%), and infection occurred mainly after neurosurgical interventions (83.8%). An external ventricular drain was inserted to administer colistin into the ventricular system in 29 cases (93.5%). The median duration for colistin therapy was 18 days. Twenty-three patients (74%) recovered, while five patients (16%) had residual disability, and three patients (10%) died. The authors concluded that IT/IVT colistin therapy is safe and effective as either the primary or adjunct treatment for antibiotic-resistant cases with CNS infection.
Highlights
Infections of the central nervous system (CNS) may develop in patients with traumatic brain injury after external ventricular drainage insertion and, broadly, after any neurosurgery procedure
Various bacteria are responsible for these infections, especially Staphylococcus epidermidis, but Gram-negative bacteria are responsible for almost 15% of CNS infections
It has been shown that the extensive use of antibiotics after neurosurgical CNS infections might alter their epidemiology
Summary
Infections of the central nervous system (CNS) may develop in patients with traumatic brain injury after external ventricular drainage insertion and, broadly, after any neurosurgery procedure. Many patients with CNS infections develop systemic and neurologic complications, with potential sequelae in the survivors and substantial mortality. These infections require prompt diagnosis and management, which depend mainly on the local epidemiology and patterns of antibiotic resistance of common pathogens [1,2]. Colistin is a complex mixture of polym polymyxin E1 and polymyxin E2 It was the first antibiotic with onf o8 table i against P. aeruginosa [1]. ISsevceormal bmacotenrilayhaavpepbleiceodmeinsuCscNepStibilnefection only to TcohliisstinstaunddypoaliymmyexdintoB.aCsosleisstisntihs ea ceofmfepclteixvmenixetusrseooff pITol/yImVyTxicnos,limsatiinnlytherapy polymyxin E1 and polymyxin E2 It was the first antibiotic with notable in vitro activity agoauintstoPt.haeerrugainnotsiab[i1o].tics, for the treatment of antibiotic-resistant CNS infection ricCpoolisptiunlbaetgioann,toabsetuhseedeixnisthtientgreaetmviednet nofcme uinltidtrhueg-lrietseisrtaantut Are. biasummanonsitiliyn-about fewctiiotnhsl[i6t]t.leHeowmepvehra, ssiinsceotnhepreedisiaatlirmicitpedaptieennettrsataiopnaorft ifnrtoramvenscoausttceorleisdtinctaostehereports cerebrospinal fluid, IT or IVT treatment is commonly applied in CNS infections [7].
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