Acinetobacter species meningitis in children: a case series from Karachi, Pakistan

  • Ali Faisal Saleem The Aga Khan University Hospital, Karachi, Pakistan
  • Muhammad Shafaat Shah The Aga Khan University Hospital, Karachi, Pakistan
  • Abdul Sattar Shaikh The Aga Khan University Hospital, Karachi, Pakistan
  • Fatima Mir The Aga Khan University Hospital, Karachi, Pakistan
  • Anita K M Zaidi The Aga Khan University Hospital, Karachi, Pakistan

Abstract

Introduction: Multidrug-resistant strains of Acinetobacter pose a serious therapeutic dilemma in hospital practice, particularly when they cause meningitis, as the few antimicrobial agents to which these isolates are susceptible have poor central nervous system (CNS) penetration. 

Methodology: We retrospectively reviewed the clinical course and outcome of eight consecutive cases of meningitis due to Acinetobacter spp. in children ages 15 years or less, seen in a tertiary care medical center in Karachi, Pakistan.

Results: Of the eight cases of Acinetobacter meningitis, isolates from five patients were pan-resistant, and two were multidrug-resistant. A neurosurgical procedure was performed in five of eight patients followed by external ventricular drain insertion prior to the development of infection. Seven received intravenous (IV) polymyxin (mean; 12.8 days), while 5/8 also received intrathecal (IT) polymyxin (mean; 12.0 days). The mean length of hospitalization was 38.7 ± 19 days. All patients achieved cerebrospinal fluid (CSF) culture negativity by the end of treatment (mean; 5.4 days). Two patients died: one with pan-resistant Acinetobacter, and the second with a multi-drug resistant isolate.

Conclusion: Post-neurosurgical multidrug-resistant and pan-resistant Acinetobacter meningitis can be successfully treated if appropriate antimicrobial therapy is instituted early. The role of IT polymyxin B administration alone versus combination therapy (IV and IT) needs further study.  

Author Biographies

Ali Faisal Saleem, The Aga Khan University Hospital, Karachi, Pakistan

Fellow Pediatric Infectious Diseases

MSc Clinical Research.

Department of Pediatrics and Child Health

Aga Khan University Hospital, Karachi

Dr Saleem has 12 indexed publication.


Dr. Ali Faisal Saleem received research training support from the National Institute of Health’s Fogarty International Center (1 D43 TW007585-01)

Muhammad Shafaat Shah, The Aga Khan University Hospital, Karachi, Pakistan

Pediatric Resident,

Department of Pediatrics and Child Health

Aga Khan University Hospital, Karachi

Abdul Sattar Shaikh, The Aga Khan University Hospital, Karachi, Pakistan

Department of Pediatrics and Child Health

Aga Khan University Hospital, Karachi

Fatima Mir, The Aga Khan University Hospital, Karachi, Pakistan

Dr. Fatima Mir received research training support from the National Institute of Health’s Fogarty International Center (1 D43 TW007585-01)

Senior Instructor. Pediatric Infectious Diseases.

The Aga Khan University Hospital. Karachi. Pakistan

Anita K M Zaidi, The Aga Khan University Hospital, Karachi, Pakistan

Professor and Chair of Department of Pediatrics and Child Health.

Consultant Pediatric Infectious diseases

The Aga Khan University Hospital, Karachi. Pakistan

Published
2011-11-10
How to Cite
Saleem A, Shah M, Shaikh A, Mir F, Zaidi A (2011) Acinetobacter species meningitis in children: a case series from Karachi, Pakistan. The Journal Of Infection In Developing Countries 5 (11): 809-814. https://doi.org/10.3855/jidc.1697
Section
Case Reports

Keywords

multidrug-resistant Acinetobacter meningitis; mortality; children; neurosurgical procedure