Successful treatment of ceftazidime-resistant Klebsiella pneumoniae ventriculitis with intravenous meropenem and intraventricular polymyxin B: case report and review.
Increasing prevalence of multidrug-resistant gram-negative organisms has led to a rise in clinically significant infections with these organisms and an increasing therapeutic dilemma. We present a case of a neurosurgical patient who developed ventriculoperitoneal shunt-associated ventriculitis due to ceftazidime-resistant Klebsiella pneumoniae susceptible to cefepime, imipenem, meropenem, and polymyxin B only. Successful management was accomplished by removal of the shunt and therapy with systemic meropenem and intraventricular polymyxin B. Rapid cerebrospinal fluid (CSF) sterilization occurred, with CSF bactericidal titers of 1:32 to 1:128. Polymyxin B should be considered as adjunctive therapy for life-threatening multidrug-resistant gram-negative infections. Prior literature on use of intrathecal polymyxin B in therapy for meningitis supports its potential efficacy.
Segal-Maurer
S
S
New York Hospital Medical Center of Queens, Flushing 11355, USA. cmurban%Queens@NYH.med.cornell.edu
Mariano
N
N
Qavi
A
A
Urban
C
C
Rahal
J J
JJ
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002442:Ceftazidime; D002555:Cerebrospinal Fluid / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007276:Injections, Intraventricular; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000235:genetics / Q000302:isolation & purification; D000077731:Meropenem; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D013845:Thienamycins / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D002442:Ceftazidime; D000077731:Meropenem; D011112:Polymyxin B