Successful treatment of extensively drug-resistant Acinetobacter baumannii ventriculitis with intravenous plus intraventricular tigecycline- a case report [PublishAheadOfPrint]

A 70-year-old woman was adimittetd with subarachnoid haemorrhage. The patient underwent cerebral aneurysm embolization. On hospital day 14, the patient underwent a lumbar subarachnoid continuous drain insertion because of fever and enlarged ventricles were showed on the head computed tomography. On hospital day 19, the patient presented with remittent fever (peak at 39.1 °C) associated with altered mental status. Cerebro-Spinal Fluid (CSF) revealed white blood cell (WBC) count of 53484/mm3 (polymorphonucleocytes,75.4%; monocytes, 24.6 %), red blood cells (RBCs) were +++/HP, glucose was 1.26 mg/dL, and the total proteinwas 14.2 g/dL. The lumbar subarachnoid continunous drain was removed. The patient was started on meropenem 1g intravenous(IV) every 8 h and vancomycin 1g (IV ) every 12h. On hospital day 22, the patient's CSF culture showed that A. baumannii (polymyxin susceptibility was not tested) was susceptible only to tigecycline (MIC ≤1 μg/mL) and cefoperazone sulbatan. The same strain of A. baumannii was isolated from the sputum and blood. With permission, the antimicrobial therapy was changed to intravenous tigecycline (100mg first then 50 mg q12h) and cefoperazone sulbatan (3g q8h). Head computed tomography (CT) demonstrated enlarged ventricles compared with previous studies and an external ventricular drain (EVD) was inserted on hospital day 25. On hospital day 28, the blood culture was negative, however the same strain of A. baumannii was still isolated from the CSF. With permission, tigecycline 2mg intraventricular (IVT) every 12 h was started and lasted for 10 days. On hospital day 38, the patient's CSF culture was negative. On hospital day 104, the patient was discharged. Continued 3-month-follow-up showed no recurrence.

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