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

Overview

Journal Infect Drug Resist

Publisher Dove Medical Press

Date 2024 Aug 19

PMID 39157745

Authors

Yingjie Zhang

Guokuo Hou

Liping Zhang

Shanshan Li

Affiliations

Soon will be listed here.

Abstract

Background: Central Nervous System (CNS) infections caused by Carbapenem-resistant (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) (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.

Citing Articles

Treatment of pediatric central nervous system infection caused by carbapenem-resistant with ceftazidime/avibactam, two cases report and literature review.

Qing L, Zhang H, Pan X, Liu Z Front Pharmacol. 2025; 16:1532608.

PMID: 40061952 PMC: 11885231. DOI: 10.3389/fphar.2025.1532608.

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