Ceftazidime-Avibactam for the Treatment of Post-Neurosurgical Meningitis Caused by a Klebsiella pneumoniae carbapenemase (KPC)-Producing Klebsiella pneumoniae

Abstract

Background. Infections of the central nervous system (CNS) caused by multidrug-resistant Gram-negative organisms are difficult to treat due to limited CNS penetration of antimicrobials, Treatment of such infections often requires intraventricular and systemic administration of antibiotics. Here, we describe a case of meningitis caused by a KPC-producing K. pneumoniae successfully treated with ceftazidime-avibactam monotherapy.Case presentation: A 27-year old man was admitted to the hospital after sustaining severe traumatic brain injury undergoing left-sided hemicraniectomy. Two weeks after hospitalization, the patient was noted to have an extra-axial fluid collection underneath his surgical site. The patient was taken to the operating room for a wash-out of the hemicraniectomy site. K. pneumoniae was isolated from his cerebrospinal fluid which exhibited a multidrug resistance phenotype including resistance to carbapenems. Due to the complex nature of the patient's skull fractures, poor wound healing at the hemicraniectomy site and the possibility of disseminating the infection into the deep ventricular system, the patient was deemed to be a poor candidate for an external ventricular drain (EVD). Patient was started on ceftazidime-avibactam 2.5 g given intravenously every 6 h monotherapy for the treatment of meningitis.