Nosocomial neonatal meningitis with Acinetobacter baumannii on myelomeningocele
Imipenem-resistant Acinetobacter baumannii meningitis is a hospital-acquired infection, the treatment of which constitutes a real therapeutic challenge. In this article, together with a review of the literature, we report two cases of imipenem-resistant Acinetobacter baumannii neonatal meningitis following ruptured myelomeningocele, treated with intravenous colistin with favorable results. In recent years, Acinetobacter baumannii has become a more and more commonly described pathogen in hospital-acquired infections. However, the cases of meningitis are mainly postoperative and are still not quite frequently described in the literature.
Two newborns, full-term, delivered by caesarean section presented a ruptured myelomeningocele. Initially, the management was done on an outpatient basis.
The first newborn upon admission was conscious, febrile, with generalized clonic seizures, chewing and pedaling, with no signs of respiratory or circulatory distress. The clinical examination showed an axial hypotonia with a bulging anterior fontanel, were weak, in addition to an omphalitis, a polymalformative syndrome comprising ruptured myelomeningocele which was infected, congenital bilateral hip dislocation, arthrogryposis, and bilateral varus clubfoot deformity.
The second newborn was conscious, febrile with signs of sepsis and convulsions including chewing, boxing and revulsion of the eyes with signs of respiratory and circulatory distress. The clinical examination found axial hypotonia with normally tense anterior fontanel, in addition to a polymalformative syndrome comprising fissured myelomeningocele, equine varus clubfoot and genu recurvatum deformities bilaterally.
Examination of the cerebrospinal fluid, by transfontanellar puncture, found a multi-resistant Acinetobacter baumannii sensitive to colistin. Lab tests also showed an inflammatory syndrome.
For both newborns, trans-fontanellar ultrasound showed signs of ventriculitis, with tri-ventricular hydrocephalus corroborated by cerebral computed tomography.
After the results of the antibiogram, we didn't have any choice in these cases for antibiotics. Only colistin was effective and the newborns were placed on intravenous colistin at a dose of 100.000 IU/kg/day in 3 doses for 7 weeks, with a favorable outcome.
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Reference: Fouad A et al, (2018). Nosocomial Neonatal Meningitis with Acinetobacter baumannii on Myelomeningocele: A Real Therapeutic Challenge, The Open Infectious Diseases Journal. DOI: 10.2174/1874279301810010043
Faizan ul Haq