APPEARANCE OF RESISTANCE TO MEROPENEM DURING THE TREATMENT OF A PATIENT WITH MENINGITIS BY ACINETOBACTER

A case is reported of a patient who developed Acinetobacter meningitis after an external ventricular drainage system had been fitted for con trol of intracranial pressure. During the process, nine strains of Aci netobacter isolated from her cerebrospinal fluid were indistinguishabl e by analysis of total genomic DNA by pulse-field gel electrophoresis. The first eight strains were sensitive to meropenem and imipenem (MIC s < 1 g/l). The MIC of the last one, which had been recovered after 32 days during two courses of treatment with meropenem, increased to > 3 2 g/l for meropenem, while with imipenem the increase Nas minimal (MIC = 1.5 g/l). The microorganism persisted in the central nervous system despite the administration of different antimicrobials, including int raventricular aminoglycosides and six changes in the external ventricu lar system. The patient died 68 days after admission to the intensive care unit from bilateral cerebral ischemic lesions, intraventricular h emorrhage and cerebral edema with endocraneal hypertension, the Acinet obacter ventriculitis also contributing to this state.