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Case Reports
. 2024 Aug 12:17:3501-3506.
doi: 10.2147/IDR.S465004. eCollection 2024.

Ceftazidime-Avibactam for the Treatment of Central Nervous System Infection Caused by Pan Drug-Resistant Carbapenem-Resistant Klebsiella Pneumoniae: A Case Report

Yingjie Zhang #  1 , Guokuo Hou #  1 , Liping Zhang  1 , Shanshan Li  1
Affiliations
Case Reports

Ceftazidime-Avibactam for the Treatment of Central Nervous System Infection Caused by Pan Drug-Resistant Carbapenem-Resistant Klebsiella Pneumoniae: A Case Report

Yingjie Zhang et al. Infect Drug Resist. .

Abstract

Background: Central Nervous System (CNS) infections caused by Carbapenem-resistant Klebsiella pneumoniae (CRKP) pose a major clinical challenge and are associated with high mortality rates. Polymyxin is used as a salvage treatment for CRKP CNS infection; however, heteroresistance to polymyxin may impact clinical outcomes. In this study, we report a rare case of polymyxin-resistant Klebsiella intracranial infection, which was successfully treated with intravenous and intraventricular antibiotic injections.

Case presentation: A 46-year-old woman with a 1-day history of post-traumatic disturbance of consciousness and cerebrospinal fluid (CSF) rhinorrhea was referred to our hospital. She underwent external ventricular drainage and decompressive craniectomy, and had a persistent fever. A CSF test confirmed intracranial infection. The minimum inhibitory concentration of polymyxin in this patient was 16 μg/mL. She was diagnosed with polymyxin-resistant pan drug-resistant (PDR) Klebsiella pneumoniae (PDR-Kp) intracranial infection. We successfully treated the infection using intravenous ceftazidime/avibactam (CAZ/AVI) and polymyxin B, combined with an intraventricular injection of polymyxin B according to the CSF microbiological culture results.

Conclusion: CAZ/AVI combined with polymyxin B may be an effective salvage treatment for CNS infections caused by polymyxin-resistant PDR-KP.

Keywords: CNS infection; Carbapenem-resistant Klebsiella pneumoniae; ceftazidime/avibactam; polymyxin-resistant.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Patient’s brain computed tomography. (A) The first brain CT in our hospital.Red arrow represents left cerebellar hematoma. (B) On the 15th day of hospitalization, the patient had sudden bilateral pupillary dilatation and the brain CT revealed hydrocephalus. (C) CSF culture was negative, and the brain CT revealed hydrocephalus relief; however, there was a separation of the fourth ventricles.Red arrow represents the fourth ventricle dilated.
Figure 2
Figure 2
Clinical course of treatment for this case.
See this image and copyright information in PMC

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