Treatment approaches for MDR Acinetobacter baumannii CNS in an infant: a case report on external ventricular drain vs Ommaya reservoir
Abstract
Background. Central nervous system (CNS) infections, such as meningoencephalitis caused by A. baumannii, present significant treatment challenges, particularly when complicated by seizures. A notable management challenge in such cases is selecting the most appropriate method for cerebrospinal fluid (CSF) drainage, between the Ommaya reservoir and the external ventricular drain (EVD). However, there is limited data comparing their efficacy in neonates or infants with CNS infections, especially when further complicated by seizures and pneumonia. Case report. A two-month-old infant was transferred to the High Care Unit (HCU) of Saiful Anwar Hospital from a general ward due to recurrent seizures. The patient had been previously diagnosed with congenital hydrocephalus and sacral meningocele. Surgical excision of the meningocele was performed, but unfortunately, it ruptured, most likely leading to an MDR Acinetobacter baumannii infection, which progressed to meningoencephalitis and pneumonia. Intravenous antibiotics were initiated, and an EVD was inserted to manage the hydrocephalus. Initially, the patient responded well, however, the EVD became clogged multiple times, forcing the medical team to switch to an Ommaya reservoir in an effort to reduce infection risk and enable intraventricular antibiotic administration. Unfortunately, the Ommaya reservoir failed to adequately address the elevated intracranial pressure, resulting in a worsening neurological condition. The clinical…
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