Combined Strategy for Post-Operative Patients with Central Nervous System Infections Caused by Extensively Drug-Resistant/Pan-Drug-Resistant Acinetobacter baumannii: A Retrospective Study

Background: Post-operative central nervous system infections (PCNSIs) caused by extensively drug-resistant (XDR) or pan-drug-resistant (PDR) Acinetobacter baumannii are rare but intractable problems. To investigate a potential combined strategy to treat Acinetobacter baumannii organisms that are resistant to not only meropenem but also colistin. Methods: We retrospectively reviewed cerebrospinal fluid positive culture isolates of Acinetobacter baumannii in patients who underwent neurosurgery. Medical records were collected by standard forms and analyzed. Results: Sixteen patients met the criteria and most patients were middle-aged males who had undergone craniotomy or endonasal trans-sphenoidal surgery. A total of 68.8% Acinetobacter baumannii isolates were XDR bacteria, and 18.8% of isolates were PDR bacteria. Twelve patients were treated by meropenem-based regimen strategy. Another four patients were administered tetracycline-based regimens. A total of 93.8% patients were treated with therapeutic drainage and strict hygiene rules were followed. Finally, 12 patients survived their infections, and the average Glasgow Outcome Scale score was 2.9 +/- 1.4 at discharge. The mortality rates of carbapenem-resistant Acinetobacter baumannii (CRAB) were 8.3%. Conclusions: Post-operative central nervous system infections caused by XDR/PDR Acinetobacter baumannii are a rare and serious complication. Combined therapy based on the individual situation, including appropriate antimicrobial agents, surgical management, and strict hygiene management might be an effective therapeutic strategy.