Lumbar Cistern Drainage and Gentamicin Intrathecal Injection in the Treatment of Carbapenem-Resistant Klebsiella Pneumoniae Intracranial Infection After Intracerebral Hemorrhage craniotomy: A Case Report

Abstract

Background: Intracranial infection is a common complication caused by craniotomy. In particular, patients in Intensive Care Units (ICU) are prone to intracranial infection with multiple drug-resistant bacteria. Due to the lack of sensitive antibiotics for the treatment of multiple drug-resistant bacteria, there are few literatures focusing on the treatment of intracranial infection, and patients often fail to receive unified and standardized treatment. Consequently, patients with Carbapenem-resistant bacteria intracranial infection report poor prognosis and high mortality. It is very important to discuss how to treat patients with intracranial infection caused by multidrug resistant bacteria.

Case presentation: We reported a case of intracranial infection of Carbapenem-resistant Klebsiella pneumoniae(CRKp) due to high flap tension, poor wound healing and CSF leakage caused by subcutaneous fluid accumulation after intracerebral hemorrhage craniotomy. Since the patient was exposed to intracranial infection resulted from subcutaneous fluid accumulation, we adopted the method of continuous drainage with subcutaneous tube. When subcutaneous effusion disappeared, the subcutaneous drainage tube was pull out, while patients exhibited high fever again, the waist big pool drainage catheter and continuous drainage were carried out. According to the result of Subcutaneous effusion and CSF culture indicated multiple drug resistant Klebsiella pneumoniae intracranial infection and drug susceptibility, The treatment of gentamicin intrathecal injection, intravenous use amikacin and oral Paediatric Compound Sulfamethoxazole Tablets was adopted, the condition of intracranial infection was eventually controlled, with the consciousness restored. This patient was characterized by intracranial infection with Carbapenem-resistant Klebsiella pneumoniae(CRKp).

Conclusions: Subcutaneous effusion is a high-risk factor for poor wound healing and interventions are required to be conducted to promote healing as early as possible to contribute to decreasing the menace of CSF leakage. In this case, Continuous drainage and intrathecal injection of sensitive antibiotics serve as critical process to determine the best strategy for clinical treatment of intracranial infection.

Keywords: carbapenem-resistant Klebsiella pneumoniae; gentamicin; intracranial infection; intrathecal injection; lumbar cistern drainage.

Figure 1

Brain CT after admission in patient with intracranial CRPK infection. (A) Before craniotomy on Apr 18. (B) After craniotomy on Apr 19. (C) After craniotomy on Apr 21, subdural effusion can be seen. (D) After craniotomy on Apr 24, a small amount of subdural effusion appeared. (E) After craniotomy on May 10, Subdural Effusion has developed significantly. (F) After cerebrospinal fluid leakage and intracranial infection on May 14, subcutaneous drainage tube was inserted, subdural Effusion decrease. (G) After cerebrospinal fluid leakage and intracranial infection on May 17, Subdural Effusion disappear. (H) enhanced CTbrain scanning showed no brain abscess on May 17. (I) After the treatment of anti-infective regimen on May 24. (J) After the treatment of anti-infective regimen on May 30, Ventricular Dilatation was observed.

Figure 2

Location of subcutaneous drainage tube and method of compression in skull defect area. (A) Location of subcutaneous drainage tube. (B) A sport headband is used to pressurize the skull defect area.

Figure 3

Changes in cerebrospinal fluid (CSF) in patient with intracranial A. baumannii infection before and after treatment. (A) CSF on May 19; (B) CSF on May 28.