Successful treatment of serious meningitis caused by extremely carbapenem-resistant enterobacter cloacae (MIC≥16mg/L) with i.v. meropenem and i.v. amikacin plus intraventricular amikacin

Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) meningitis are associated with poor outcomes and high mortality. Here, we report the first successful treatment case of serious meningitis caused by extremely carbapenem-resistant Enterobacter cloacae (minimum inhibitory concentration (MIC) of imipenem ≥16mg/L) with high-dose prolonged infusion of meropenem and i.v. amikacin plus intraventricular (IVT) amikacin. Case presentation: A 17-year-old girl developed meningitis from an extremely carbapenemresistant Enterobacter cloacae (MIC of imipenem ≥16mg/L) as a complication of the removal of a giant central neurocytoma located in bilateral and third ventricles. The patient received four surgeries (one tumor excision and three external ventricular drainages) and was treated with a 70 days course of antibiotics therapy during 100 days hospitalization. Finally, she was safely and successfully treated with the high-dose prolonged infusion of meropenem and i.v. amikacin plus IVT amikacin. Conclusion: This case report shows the possibility of the antibiotic regimen of high-dose prolonged infusion of meropenem and i.v. amikacin plus IVT amikacin in the successful treatment of CRE meningitis (MIC of imipenem ≥16mg/L) especially when other antibiotics are unavailable or restricted.