Management of meningitis due to antibiotic-resistant Acinetobacter species

Baek-Nam, Kim, Peleg, Anton Y., Lodise, Thomas P., Lipman, Jeffrey, Li, Jian, Nation, Roger and Paterson, David L. (2009) Management of meningitis due to antibiotic-resistant Acinetobacter species. Lancet Infectious Diseases, 9 4: 245-255. doi:10.1016/S1473-3099(09)70055-6

Author Baek-Nam, Kim
Peleg, Anton Y.
Lodise, Thomas P.
Lipman, Jeffrey
Li, Jian
Nation, Roger
Paterson, David L.
Title Management of meningitis due to antibiotic-resistant Acinetobacter species
Journal name Lancet Infectious Diseases   Check publisher's open access policy
ISSN 1473-3099
Publication date 2009-04
Year available 2009
Sub-type Article (original research)
DOI 10.1016/S1473-3099(09)70055-6
Volume 9
Issue 4
Start page 245
End page 255
Total pages 11
Editor John McConnell
Place of publication London, United Kingdom
Publisher The Lancet Publishing Group
Collection year 2010
Language eng
Subject 110309 Infectious Diseases
920109 Infectious Diseases
Abstract Acinetobacter meningitis is becoming an increasingly common clinical entity, especially in the postneurosurgical setting, with mortality from this infection exceeding 15%. Infectious Diseases Society of America guidelines for therapy of postneurosurgical meningitis recommend either ceftazidime or cefepime as empirical coverage against Gram-negative pathogens. However, assessment of the pharmacodynamics of these cephalosporins in cerebrospinal fluid suggests that recommended doses will achieve pharmacodynamic targets against fewer than 10% of contemporary acinetobacter isolates. Thus, these antibiotics are poor options for suspected acinetobacter meningitis. From in vitro and pharmacodynamic perspectives, intravenous meropenem plus intraventricular administration of an aminoglycoside may represent a superior, albeit imperfect, regimen for suspected acinetobacter meningitis. For cases of meningitis due to carbapenem-resistant acinetobacter, use of tigecycline is not recommended on pharmacodynamic grounds. The greatest clinical experience rests with use of polymyxins, although an intravenous polymyxin alone is inadvisable. Combination with an intraventricularly administered antibiotic plus removal of infected neurosurgical hardware appears the therapeutic strategy most likely to succeed in this situation. Unfortunately, limited development of new antibiotics plus the growing threat of multidrug-resistant acinetobacter is likely to increase the problems posed by acinetobacter meningitis in the future.
Keyword Infectious Diseases
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
2010 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 64 times in Thomson Reuters Web of Science Article | Citations
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Created: Wed, 09 Sep 2009, 15:52:41 EST by Carmen Buttery on behalf of UQ Centre for Clinical Research