Yingjie Zhang,* Guokuo Hou,* Liping Zhang, Shanshan Li

Department of Neurosurgery ICU, The Second Hospital & Clinical Medical School, Lanzhou University, Academician Workstation of The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Shanshan Li, Tel +8615193185275, Fax +86-931-15193185275, Email 15193185275@163.com

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, polymyxin-resistant, ceftazidime/avibactam