Intraventricular Colistin for the Treatment of Multidrug-Resistant Pseudomonas Aeruginosa Shunt Infection

Abstract

Purpose

To report a case of ventriculoperitoneal shunt (VPS) infection with multidrug-resistant (MDR) Pseudomonas aeruginosa infection treated successfully with intraventricular colistin.

Summary

A 56-year-old black woman with a known history of sub-arachnoid hemorrhage and hydrocephalus necessitating VPS placement experienced fever, headache, and neck pain several weeks after she underwent emergent colectomy with ileostomy for Clostridium difficile colitis. Fever and neck stiffness were significant on examination. The patient's laboratory data demonstrated elevated cerebrospinal fluid (CSF) white blood cell count and protein level. A culture of the CSF grew P. aeruginosa and Enterococcus faecalis. Despite multiple antibiotic regimens and removal of the shunt, the CSF cultures continued growing P. aeruginosa. Intraventricular colistin was initiated as monotherapy, and colistin successfully sterilized the CSF within 24 hours. The patient developed severe headache and confusion, which her physicians thought was colistin-induced arachnoiditis; this condition resolved rapidly on discontinuation of therapy.

Discussion

The emergence of MDR, gram-negative microorganisms is a major concern for health care professionals worldwide. The rapid appearance of these organisms has led to a concurrent increase in central nervous system (CNS) infections caused by such bacteria. Furthermore, the clinical value of antibiotics that remain active against MDR, gram-negative bacteria in the CNS is limited by their decreased penetration of the blood-brain barrier. There is a revived interest in the use of intrathecal or intraventricular colistin to ensure adequate drug concentrations at the site of infection.

Conclusion

Intrathecal or intraventricular administration of colistin appears to be an appealing therapeutic option for CNS infections, especially in life-threatening emergencies. Further studies are needed to clarify the role of intrathecal colistin for treating MDR, gram-negative CNS infections.

Keywords

colistin central nervous system (CNS) infection ventriculoperitoneal shunt (VPS) infection

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