Keywords
Multidrug resistance
Infection
Central nervous system
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Abstract
Objective: To analyze resistance patterns, clinical challenges and treatment possibilities in central nervous system (CNS) infections caused by multidrug-resistant Acinetobacter baumannii. Literature review: Multidrug-resistant Acinetobacter baumannii infections present in the CNS have been a major clinical challenge, especially when associated with neurosurgery or traumatic brain injury. Current treatment for CNS infections caused by multidrug-resistant A. baumannii consists of the combined intravenous administration of agents such as: carbapenems with ampicillin/sulbactam; carbapenems associated with colistin; colistin with rifampicin and sulbactam; and tigecycline associated with rifampicin and ampicillin. However, due to the low permeability of these agents across the blood-brain barrier, the use of intrathecal antimicrobial therapy should be considered and the main agents are: colistin, tigecycline, gentamicin, amikacin and polymyxin B. Final considerations: A. baumannii has become one of the pathogens most challenging conditions acquired in hospital environments. The difficulty for antimicrobials to penetrate the blood-brain barrier, combined with the mechanisms of resistance of this microorganism to antimicrobials, make infectious control difficult and therefore favor a high mortality rate in meningoencephalitis. It is essential to detect it early and adopt strict infection control procedures. Clinical trials are needed to better ensure the best antimicrobial choice and treatment time.
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