Intraventricular Plus Systemic Antibiotic Therapy for Treating Polymyxin-Resistant Klebsiella pneumoniae Ventriculitis: A Case Report

BACKGROUND: Treating central nervous system (CNS) infections caused by extensively drug-resistant (XDR) gram-negative bacilli, such as carbapenem-resistant Klebsiella pneumoniae, represents a significant clinical challenge. Polymyxin is occasionally used as a salvage treatment for this severe CNS infection. We report here a rare case of polymyxin-resistant Klebsiella pneumoniae ventriculitis, which was successfully treated with ventricular injections and intravenous antibiotics. METHODS: A 53-year-old male underwent a decompressive craniectomy and was referred to our hospital with cerebrospinal fluid incisional leakage and persistent fever. RESULTS: The minimum inhibitory concentration of polymyxin B in this patient increased from 2 to 4 μg/mL during the course of treatment. He was diagnosed with polymyxin-resistant XDR Klebsiella pneumoniae ventriculitis. We successfully treated the infection with intravenous ceftazidime/avibactam (CAZ/AVI) combined with ventricular injection of tigecycline according to cerebrospinal fluid microbiological culture. CONCLUSIONS: CAZ/AVI combined with tigecycline may be an effective salvage treatment for CNS infections caused by polymyxin-resistant XDR Klebsiella pneumoniae.