Acinetobacter Baumannii 'e Bağlı Gelişen Beyin Apsesi Olgusu

Bu makalede, başından ateşli silah yaralanması nedeniyle beyin cerrahisi bölümünde opere edilen, takibinde menenjit ve beyin absesi gelişen, yapılan kültürde çok ilaca dirençli Acinetobacter baumannii üreyen 23 yaşında bir bayan hasta sunuldu. Tedavide parenteral sulbaktam (3x2 gr I.V.) ve kolistin (3x150 mg I.V.)'e ilaveten intratekal (1x10 mg) kolistin tedavisi uygulandı. Bu tedaviyle hasta iyileşti. Beyin cerrahisi sonrası çok ilaca dirençli Acinetobacter baumannii’ye bağlı olarak gelişen beyin abselerinin mortalite oranları yüksek, tedavi seçenekleri kısıtlı olduğundan bu hastalarda parenteral tedaviye ek olarak intratekal kolistin tedavisinin düşünülmesi gerekir. Çok ilaca dirençli Acinetobacter baumannii’ye bağlı beyin apsesi nadir olduğundan bu vaka sunulmaya değer bulundu.

Anahtar Kelimeler:

Acinetobacter baumannii, Beyin absesi, intratekal kolistin

A Case Brain Abces due to Acinetobacter Baumannii

In this article, A 23-year-old female patient with menengitis and brain abces due to multy drug resistant Acinetobacter baumannii presents who had been operated in the brain surgery department due to a gunshot injury in her head. Intrathecal (1x10 mg) colistin treatment was performed in addition to sulbactam (3x2 gr I.V.) and colistin (3x150 mg I.V.). The patient is treated with this treatment. Because of the high mortality rates and limited treatment options of the brain abces due to the multy drug resistant Acinetobacter baumannii after brain surgery, intrathecal colistin treatment should be kept in mind in addition to parenteral treatment in these patients. I present this case because of the brain abces due to Acinetobacter baumannii is rare.

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1- Gantz NM, Godofsky EW. Nosocomial central nervous system infections, pp: 246-69. In: Mayhall CG (ed), Hospital Epidemiology and Infection Control. 1996, Williams & Wilkins, Baltimore. 2- Weisfelt M, van de Beek D, Spanjaard L, de Gans J. Nosocomial bacterial meningitis in adults: a prospective series of 50 cases. J Hosp Infect 2007; 66: 71-8. 3- Aktaş O, Keşli R, Yazgı H. Eksternal ventriküler drenaj sistemiyle ilişkili Acinetobacter baumanii menenjiti. AÜTD 2000; 32:127-9. 4- Wang KW, Chang WN, Huang CR, et al. Postneurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes. J Clin Neurosci 2005; 12: 647-50. 5- Iraz M, Ceylan A, Akkoyunlu Y. Çeşitli klinik örneklerden izole edilen Acinetobacter türlerinde antibiyotik direnç oranlarının incelenmesi. ANKEM Derg 2012;26(2):80-85 doi:10.5222/ankem.2012.080 6- Kireçci E, Kireçci M, Aksu M, Klinik Örneklerden İzole Edilen Acinetobacter baumannii Türlerinin Antibiyotiklere Duyarlılıklarının Araştırılması. Türk Mikrobiyol Cem Derg 44(2):65-69, 2014 doi:10.5222/TMCD.2014.065 7- Metan G, Alp E, Aygen B, Sümerkan B. Carbapenem resistant Acinetobacter baumannii: an emerging threat for patients with post neurosurgical meningitis. Int J Antimicrob Agents 2007; 29:112-3. http://dx.doi.org/10.1016/j.ijantimicag.2006.08.0 35 8- Ceylan B, Arslan F, Sipahi O.R, Sunbul M, Ormen B, Hakyemez İ.N, Turunc T, Yıldız Y, Karsen H, Karagoz G, Tekin R, Hizarci B. Variables determining mortality in patients with Acinetobacter baumannii meningitis/ventriculitis treated with intrathecal colistin. Clinical Neurology and Neurosurgery Volume 153, February 2017, Pages 43 - 49 9- Tuon FF, Penteado-Filho SR, Amarante D, Andrade MA, Borba LA. Mortality rate in patients with nosocomial acinetobacter meningitis from a Brazilian hospital. Braz J Infect Dis 2010; 14:437-40. http://dx.doi.org/10.1590/S1413- 86702010000500003 10- Cascio A, Conti A, Sinardi L, et al. Postneurosurgical multidrug-resistant Acinetobacter baumannii meningitis successfully treated with intrathecal colistin. A new case and a systematic review of the literature. Int J Infect Dis 2010; 14:572-9. http://dx.doi.org/10.1016/j.ijid.2009.06.032 11- Rodriguez GA, Blanco A, Asensi V, et al. Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments. J Antimicrob Chemother 2008; 61:908-13. http://dx.doi.org/10.1093/jac/dkn018 12- Demir N. A., Özcan M, Özçimen S, Kacar F, Korkmaz F, Güney İ. Atipik Acinetobacter baumannii Menenjiti: Olgu Sunumu. http://www.mjima.org/ ● DOİ: 10.5578/mjima.7188