Successful treatment of multidrug-resistant Acinetobacter baumannii ventriculitis with continuous ventricular irrigation combined with intravenous tigecycline: A case report

Introduction: To report a case in which multidrug-resistant Acinetobacter baumannii (MDRAB) ventriculitis was successfully treated using continuous ventricular lavage combined with intravenous tigecycline, providing a reference for the clinical management of such complex intracranial infections. Methods: This was a retrospective analysis of the diagnosis and treatment process for a patient with extensive MDRAB ventriculitis following moyamoya disease surgery. The treatment regimens included (1) intravenous combination therapy with high-dose tigecycline, cefoperazone/sulbactam, and meropenem; (2) neuroendoscopic ventriculomyelocele evacuation; and (3) continuous ventriculostomy irrigation with tigecycline solution via a ventriculostomy tube. Case Report: A 50-year-old female patient was transferred to the Neurosurgery Intensive Care Unit at Huazhong University of Science and Technology Union Shenzhen Hospital. After 62 days of intravenous tigecycline and 19 days of intraventricular tigecycline irrigation combined with neurosurgical intervention, the patient’s cerebrospinal fluid (CSF) white blood cell count decreased from 27,773 × 106/L to normal levels, and the intracranial infection was controlled. Transient coagulation disorders and elevated liver enzymes occurred during treatment but improved after symptomatic management. The patient ultimately improved and was discharged. At the 1-year post-operative follow-up, no recurrence of infection was observed. Conclusion: For extensively drug-resistant AB ventriculitis in which first-line agents are unavailable because of drug availability or blood–brain barrier limitations, continuous ventricular lavage combined with intravenous tigecycline represents an effective salvage strategy. The success of this approach relies on multidisciplinary collaboration, thorough pharmacovigilance, and individualized neurosurgical management.