PDF(Pubmed)
Abstract：
Cerebrospinal fluid shunts are the primary treatment for hydrocephalus. However, prolonged external ventricular drain (EVD) use can lead to central nervous system (CNS) infections such as ventriculitis. In the ICU setting, nosocomial infections with gram-negative, multi-drug resistant (MDR) organisms such as Acinetobacter baumannii (AB) prevail, leading to poor outcomes. AB infections are notably challenging due to their genetic drug resistance. Colistin has been reintroduced for use against gram-negative MDR pathogens but has limitations in CNS penetration when administered intravenously. Therefore, intraventricular (IVT) or intrathecal administration of colistin is recommended to enhance its therapeutic reach within the CNS. We present a case of a 22-year-old male admitted after an electric scooter accident with head trauma and hydrocephalus. A ventriculoperitoneal (VP) shunt was inserted, complicated by a nosocomial neuroinfection. Empiric IV therapy with meropenem and vancomycin was initiated. The VP shunt culture identified AB susceptible only to colistin. Intravenous (IV) colistin was added to meropenem with no significant improvement. The addition of IVT colistin significantly improved the patient\'s neurological condition and reduced inflammatory markers. The patient experienced one myoclonic seizure during IVT colistin treatment, managed with antiepileptics. After multiple unrelated nosocomial complications, the patient was discharged in good condition to rehabilitation. This case suggests that IVT colistin, combined with IV administration, may be preferable over IV colistin alone. Medical staff should be informed about the correct prevention and care of EVD-associated infections.
摘要：
脑脊液分流是脑积水的主要治疗方法。然而,长期使用外部心室引流（EVD）可导致中枢神经系统（CNS）感染，例如脑室炎。在ICU环境中，革兰阴性医院感染，多重耐药（MDR）生物，如鲍曼不动杆菌（AB）占优势，导致糟糕的结果。由于其遗传耐药性,AB感染尤其具有挑战性。粘菌素已经被重新引入用于对抗革兰氏阴性MDR病原体,但是当静脉内施用时在CNS渗透方面具有局限性。因此,建议在脑室内（IVT）或鞘内注射粘菌素，以增强其在CNS内的治疗范围。我们介绍了一例22岁的男性，因电动踏板车发生头部外伤和脑积水而入院。插入脑室-腹膜（VP）分流术，并发了医院内的神经感染.开始使用美罗培南和万古霉素的经验性IV治疗。VP分流培养物鉴定出AB仅对粘菌素敏感。静脉注射（IV）粘菌素添加到美罗培南中，没有显着改善。IVT粘菌素的添加显著改善了患者的神经状况并降低了炎症标志物。患者在IVT粘菌素治疗期间经历了一次肌阵挛性癫痫发作，用抗癫痫药管理。在多种无关的医院并发症后，病人康复状态良好。这个病例提示IVT粘菌素,结合静脉给药，可能比单独的IV粘菌素更可取。应告知医务人员有关EVD相关感染的正确预防和护理。
