Successful treatment of multidrug-resistant Acinetobacter baumannii meningitis with ampicillin sulbactam in primary hospital

Introduction: Acinetobacter baumannii nosocomial infections, especially those due to multi-drug resistant strains, are increasingly detected. We want to find the effective treatment measures about multi-resistant Acinetobacter baumannii infections through this research. Methodology: The clinical features and the outcomes of twelve cases of nosocomial Acinetobacter baumannii meningitis treated with ampicillin sulbactam and intrathecal use of amikacin are reported in primary hospital. All the patients had fever, neck stiffness or meningeal signs, and a low consciousness level, and in their cerebrospinal fluid (CSF), pleocytosis, a low glucose level, and an elevated protein level were noted. For all CSF isolates were resistant to at least two antibiotics used in empirical therapy (third and fourth generation cephalosporins, carbapenems or piperacillin/tazobactam). Four cases sputum culture prompted the growth of Acinetobacter baumannii. Two CSF isolates were intermediate resistant to ampicillin sulbactam, only sensitive to amikacin. The two patients were treated with ampicillin sulbactam and intrathecal use of amikacin. Results: The dosages and the duration of treatment with ampicillin sulbactam were 2 g/1 g every 6 hours and 9-21days. Eleven patients were cured and one patient died of meningitis (8.3%). This patient died of severe respiratory Acinetobacter baumannii infection and severe sepsis. One patient had mild nausea and discomfort, given metoclopramide therapy. There were no serious side effects with the ampicillin sulbactam treatment. Conclusions: In conclusion, ampicillin sulbactam may be effective as therapy for meningitis caused by Acinetobacter baumannii resistant to imipenem and other beta-lactam drugs. Meanwhile, continuous lumbar external drainage and intermittent intrathecal use of amikacin were necessary methods.