Autor(es): Furtado, F ; Figueiredo, I ; Iraneta, A ; Matos, M ; Gouveia, C ; Varandas, L
Data: 2014
Identificador Persistente: http://hdl.handle.net/10400.17/4450
Origem: Repositório do Centro Hospitalar de Lisboa Central, EPE
Assunto(s): Klebsiella pneumoniae; Meningitis; Intrathecal Colistin; HDE INF PED; HDE FAR; HDE NCIR
Background: Multidrug-resistant (MDR) gram negative bacteria meningitis has become a clinical entity with increasing importance in recent years. Intrathecal colistin (ITH) has been used in the treatment of this cases. Aims: To report one case of MDR Klebsiella pneumoniae meningitis and ventriculitis successfully treated with ITH colistin. Case Report: Nine months old boy, born at 28 weeks of gestational age, diagnosed with neonatal meningitis, complicated with tetraventricular hydrocephalus requiring ventriculo-peritoneal shunt (VPS) placement and multiple shunt revisions. Admitted for worsening hydrocephalus. Cerebrospinal fluid (CSF) cultures were positive for extended-spectrum β-lactamase (ESBL) Klebsiella pneumoniae, only sensitive to meropenem and amikacin. Intravenous meropenen was started but CSF cultures remained positive and shunt device could not be removed. Although susceptibility to colistin was not available, on day 24 intrathecal colistin(4mg/day) was started through an external shunt. CSF white blood cell count improved and cultures became negative. Colistin was stopped after 19 days because of CSF pleocitosis and meropenen maintained for a total of 2 months with clinical improvement. Conclusion: In Klebsiella pneumoniae meningitis with ventriculitis, ITH colistin can be considered a safe, effective, and practicable alternative treatment when parental administration fails.
