Intrathecal Injection of Polymyxin B in a Child with Meningitis Caused by Carbapenem-Resistant Pseudomonas aeruginosa: A Case Report and Literature Review

Figures & data

Figure 1 (a) Chest CT showed pulmonary inflammation; (b) Brain CT showed ventriculomegaly on admission.

Figure 2 (a) The variation of the patient’s temperature; (b) The variation of CRP; (c) The variation of leukocytes; (d) The variation of thrombocytes.

Table 1 Susceptibility Results for P. Aeruginosa in Blood Samples

Antibiotic	MIC (μg/mL)	KB(mm)	Susceptibility	Breakpoint
Amikacin	≤2	NE	S	16–64
Aztreonam	≥64	NE	R	8–32
Ceftazidime	8	NE	S	8–32
Ciprofloxacin	≤0.25	NE	S	0.5–2
Polymyxin	≤0.5	NE	S	2–4
Cefoperazone/Sulbactam	32	NE	I	NE
Doxycycline	≥16	NE	R	NE
Cefepime	8	NE	S	8–32
Imipenem	8	NE	R	2–8
Levofloxacin	1	NE	S	1–4
Meropenem	≥16	NE	R	2–8
Minocycline	≥16	NE	R	NE
Tigecycline	≥8	NE	R	NE
Tobramycin	≤1	NE	S	4–16
Piperacillin/tazobactam	32	NE	I	16–128
Gentamycin	NE	15	S	12–15
Piperacillin	NE	14	R	14–21

Table 2 Susceptibility Results for P. Aeruginosa in Sputum Sample

Antibiotic	MIC (μg/mL)	KB(mm)	Susceptibility	Breakpoint
Amikacin	≤2	NE	S	16–64
Aztreonam	≥64	NE	R	8–32
Ceftazidime	8	NE	S	8–32
Ciprofloxacin	0.5	NE	S	0.5–2
Polymyxin	≤0.5	NE	S	2–4
Cefoperazone/Sulbactam	32	NE	I	NE
Doxycycline	≥16	NE	R	NE
Cefepime	8	NE	S	8–32
Imipenem	≥16	NE	R	2–8
Levofloxacin	1	NE	S	1–4
Meropenem	≥16	NE	R	2–8
Minocycline	≥16	NE	R	NE
Tigecycline	≥8	NE	R	NE
Tobramycin	≤1	NE	S	4–16
Piperacillin/tazobactam	32	NE	I	16–128
Gentamycin	NE	15	S	12–15
Piperacillin	NE	14	R	14–21

Abbreviations: R, resistant; S, sensitive; I, intermediary; NE, not exist; MIC, minimum inhibitory concentration.

Figure 3 (a) Chest CT showed pulmonary inflammation relieved, but cavitary lesions formed (black arrows); (b) Brain MRI of the brain revealed ventriculomegaly, along with abnormal signal intensities observed in the bilateral precornu, the left frontal lobe, and the triangular region of white matter (black arrows).

Figure 4 The timeline of the treatment and follow-up.

Table 3 Neonatal and Pediatric Cases Receiving Intrathecally or Intraventricularly of Polymyxin B

References	Year	Age/Sex	Underlying Disease	Pathogenic Bacterium	IVT/ITH Treatment	Dosage and Duration	Adverse Events	Treatment Outcome
Piparsania S^Citation5	2012	7d/M	Premature infant, hydrocephalus, ventriculitis	A. Baumannii	Polymyxin B	40000IU qod×14d	NR	Survival
Ye J^Citation6	2020	7y3m/F	Craniocerebral trauma, Craniotomy, EVD	A. Baumannii	Polymyxin B	NR×21d	N	Survival
		13y5m/M	Neurofibroma, Craniotomy, EVD	K. Pneumoniae	Polymyxin B	NR×12d	N	Death
		13y/F	Craniocerebral trauma, Craniotomy, EVD	P. aeruginosa	Polymyxin B	NR×21d	N	Survival
Xing H^Citation7	2021	14y/M	Craniopharyngioma, neurosurgical surgery	A. Baumannii	Polymyxin B	50000U qd×4d, 50000U qod×5d	SH, neurotoxicity	Survival
Fitzrol DN^Citation8	2023	NR/M	Seizure, hydrocephalus, EVD	A. Baumannii	Polymyxin B	5mg qd×19d	SH	Survival

Abbreviations: IVT, intraventricular; ITH, intrathecal; F, female; M, male; A. Baumannii, Acinetobacter baumannii; K. pneumoniae, Klebsiella pneumoniae; P. aeruginosa, Pseudomonas aeruginosa; NR, not reported; EVD, external ventricular drainage; SH, skin hyperpigmentation; qd, once every day; qod, once every other day.

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Data Sharing Statement

Data will be provided by the corresponding author upon reasonable request.