Affiliations: Department of Pediatrics, Khon Kaen University, Khon
Kaen, Thailand | Department of Surgery, Faculty of Medicine, Khon Kaen
University, Khon Kaen, Thailand
Note: [] Correspondence: Dr. Pagakrong Lumbiganon, Department of
Pediatrics, Khon Kaen University, Khon Kaen, Thailand. Tel.: +66 43 348382;
Fax: +66 43 348382; E-mail: paglum@kku.ac.th
Abstract: A term, male infant with a large frontoethmoidal
encephalomeningocele underwent a cranial defect repair with excision of
nasoencephalocele after the mass had ruptured. Two days after operation, the
wound became infected and the infant developed sepsis and meningitis due to
carbapenem-resistant Acinetobacter baumannii. Ultrasonographic study of
the brain revealed severe obstructive hydrocephalus and evidence of
ventriculitis. He was treated with intravenous netilmycin, ampicillin/sulbactam
and oral rifampicin. Four days later, the blood and cerebrospinal fluid
cultures grew no organism but the infant still had persistent thrombocytopenia
with evidence of disseminated intravascular coagulation, so colistin
5 mg/kg/day given intravenously every 8 hr was added. His condition gradually
improved. He was treated with intravenous amphotericin B concomitantly due to
nosocomial fungal infection. Colistin was given for 6 weeks; netilmycin,
ampicillin/sulbactam and rifampicin were given for 4 weeks. There was no rising
of serum creatinine even though he also received other nephrotoxic agents.
Intravenous colistin in combination with netilmycin and rifampicin may be a
potentially effective and safe therapy for meningitis caused by
carbapenem-resistant A. baumannii in infant.
Keywords: Carbapenem, A. baumannii, septicemia, meningitis, neonate, colistin
