JOURNAL OF CLINICAL MICROBIOLOGY, Sept. 2000, p. 3523 Vol. 38, No.

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Copyright © 2000, American Society for Microbiology. All Rights Reserved.

Intrathecal Use of Colistin

This letter reports a case of meningitis caused by a multire-
sistant gram-negative rod that was successfully treated with
intrathecal colistin. A 41-year-old female was admitted to the
intensive care unit due to subarachnoid hemorrhage. The com-
puterized tomography scan showed intraventricular bleeding,
At the present time, no reported data about intrathecal
colistin treatment has been published.
Recently, Levin et al. reported 60 patients with nosocomial
infections by Pseudomonas aeruginosa and Acinetobacter bau-
mannii who were treated with colistin intravenously. Only four

TABLE 1. Clinical parameters and microbiology of CSF

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Value or result on indicated date (mo-day-yr)
Parameter (unit) or test
1-10-99 1-18-99 1-19-99 1-23-99

Dextrose in CSF (mg/dl) 67 69 9 65

Leukocyte count in CSF (cells/mm3) 3 2,100 1,200 50
Protein in CSF (g/liter) 0.1 0.4 3.6 1.2
Lactic acid in CSF (mg/dl) 14.9 14 70 60
Chloride in CSF (meq/ml) 131 121 118 115
Gram stain GNRa GNR
CSF culture A. calcoaceticus A. calcoaceticus
a
GNR, gram-negative rods.
enlargement of the lateral ventricles, and a decrease in size of of five cases with good resolution had central nervous system
the fourth ventricle. The patient underwent a craneotomy for infections; however, none of them had received intrathecal
clipping of an aneurysm and we performed an external drainage. treatment (5).
The patient developed fever 8 days after the drainage. The We conclude that in cases of meningitis caused by multire-
cerebrospinal fluid (CSF) white cell count, red cell count, and sistant gram-negative rods, intrathecal administration of the
chemistry are show in Table 1. old antibiotic colistin could be considered as an effective alter-
The CSF culture grew Acinetobacter calcoaceticus (now native treatment.
REFERENCES
Acinetobacter baumannii). The susceptibility results were as 1. Bergoglio, R. M. 1985. Polymixin, p. 220–225. In Antibiotics, 4th ed. Editorial
follows: resistant to ampicillin-sulbactam, piperacillin, pipera- Medica Panamericana, Buenos Aires, Argentina.
2. Catenpole, C. R., J. M. Andrews, N. Brenwald, and R. Wise. 1997. A reas-
cillin-tazobactam, ceftazidime, cefepime, imipenem, mero- sessment of the in-vitro activity of colistin sulphomethate sodium. J. Antimi-
penem, aztreonam, gentamicin, and amikacin (NCCLS docu- crob. Chemother. 39:225–260.
ment M2-A6); susceptible only to colistin. The MIC of colistin 3. Fleischer, M., A. Pizondo-Mordarska, and J. Ruczkowska. 1991. Sensitivity of
bacteria of the genus Acinetobacter to antibiotics and ofloxacin. Med. Dos.
was 0.5 ␮g/ml, and the MIC of amikacin was 128 ␮g/ml (NCCLS Mikrobiol. 43:103–119.
document M7-A4). 4. Kunin, M. 1977. Parentheral polymixin B and colistimethate. JAMA 237:
The treatment consisted of 5 mg per day of intrathecal 1481–1482.
5. Levin, A. S., A. A. Barone, J. Penco, M. V. Santos, I. S. Marinho, E. A. G.
colistin on day 1 and 10 mg of intrathecal colistin per 24 h for Arruda, E. I. Manrique, and S. F. Costa. 1999. Intravenous colistin as therapy
21 days thereafter. for nosocomial infections caused by multidrug-resistant Pseudomona aurugi-
The CSF Gram stain and culture became negative after 24 h, nosa and Acinetobacter baumanii. Clin. Infect. Dis. 28:1008–1011.
6. Weinstein, I. 1978. Various anti-microbial agents; anti-mycotic and anti-viral
whereas the blood chemistry normalized at 48 h. agents, p. 1027–1046. In L. S. Goodman and A. Gilman (ed.), Therapeutic
The inhibitory and bactericidal activities of the CSF were pharmacological bases, 5th ed. Editorial Interamericana, Mexico.
measured right before the intrathecal injection of colistin. Both
Walter Vasen*
values were 1/8 CSF dilution. Infectious Diseases of OSPSA
The patient had a successful outcome. Six weeks after fin- Sanatorio Mitre
ishing the intrathecal treatment, the patient underwent the last Bartolomé Mitre 2553
drainage with no complications. Capital (1039), Argentina
Some cases of bacterial meningitis cannot always be treated Pablo Desmery
intravenously with conventional antimicrobial agents. Patients Santiago Ilutovich
with meningitis due to multiresistant gram-negative rods ICU
should be treated intrathecally with polymixin B or colistin; Sanatorio Mitre
Bartolomé Mitre 2553
however, due to their toxicity, these agents are not currently
Capital (1039), Argentina
used (1, 4, 6).
Multiresistant Acinetobacter spp. are frequently the etiologic Ana Di Martino
Bacteriology Laboratory
agent of nosocomial infections, and 90% of these strains are
Sanatorio Mitre
susceptible to colistin (MIC at which 90% of the isolates are Bartolome Mitre 2553
inhibited, 2 mg/liter) (3). The MIC of colistin for the strains Capital (1039), Argentina
that caused the infection in our patient was 0.5 mg/ml (2). *E-mail: wvasen@intramed.net.ar

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