Ventriculitis caused by multidrug-resistant bacteria in ICU
The present case has been reported in the Indian Journal of Critical Care Medicine.

A 34-year-old, psychosis-treated woman with a history of poorly controlled arterial hypertension was admitted with an intracerebral hemorrhage located along the frontal horn of the lateral cerebral chamber with a penetration of blood into the brain chamber system and consequent hydrocephalus for which she was promptly fitted with an EVD.

The authors did not go with intraventricular thrombolysis because of the inability to perform a reliable diagnostic test to exclude arteriovenous malformation, and the drainage of the liquor was satisfactory in the 1st day without any signs of infectious syndrome in the patient and with the tendency of recovery of the neurological status.

The drain was functioning well for 13 days, and then there was a deterioration in the neurological status of the patient (progression of the disturbance of state of consciousness), a development of febrility, where the drain becomes dysfunctional, and the liquor analysis demonstrated proteinorachy and pleocytosis with the dominance of polymorphonuclears, and we have a positive microbiological isolate from the liquor (Acinetobacter baumannii – multidrug resistant), which is only sensitive to colistin and rifampicin.

The active drain was immediately extracted, a new one was placed, and we administered colistin intrathecaly and intravenously and rifampicin and continued the vancomycin therapy according to an earlier hemoculture isolate. After 2 days, the patient spontaneously (accidentally) pulled the drain out, and the radiological control showed no deterioration of the hydrocephalus although the signs of inflammation were still maintained (proteinorachy and pleocytosis in the lumbar punctate).

In addition, the conservative measures of management of increased intracranial pressure and antibiotic therapy were applied according to the scheme: colistin intravenous, meronem in continued infusion over 3 h in high doses (Infectious Diseases Society of America [IDSA] 2017 guideline), rifampicin, and vancomycin. After 14 days, antibiotics were excluded during the normalization of laboratory parameters and without signs of infection.

Furthermore, after 14 days of repeated lumbar punctures – the findings were satisfactory, the neurosurgeon stated that there was no contraindication for the implantation of the cerebrospinal fluid (CSF) shunt, and the same one was fitted. Three weeks after the neurosurgical intervention of the CSF shunt placement, an endocranial control computed tomography scanner was performed, which was satisfactory. After that, physical rehabilitation of stationary type was carried out.

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