Alexian Brothers Medical Center, Elk Grove Village, IL, USA.
Ann Pharmacother. 2014 Feb;48(2):274-8. doi: 10.1177/1060028013510487. Epub 2013 Nov 6.
To report a case of Klebsiella pneumoniae carbapenemase (KPC)-producing K pneumoniae ventriculitis successfully treated with dual intraventricular plus systemic antibiotic therapy.
A 43-year-old woman with a ventriculoperitoneal shunt was transferred from a nursing home with fever, altered mental status, and leukocytosis. She was found to have KPC-producing K pneumoniae ventriculitis. Combination intraventricular antibiotic therapy with colistin and gentamicin plus systemic colistin and amikacin led to the resolution of infection.
Utilization of intraventricular or intrathecal antibiotics has been described in the literature for multidrug resistant (MDR) Gram-negative central nervous system (CNS) infections; however, none of the cases were caused by a KPC-producing organism. Given the pathogenicity and limited treatment options for this resistant organism, we utilized intraventricular colistin 10 mg and intraventricular gentamicin 10 mg in combination with systemic colistin and amikacin. An extensive literature search revealed several case reports and case series of documented MDR Acinetobacter baumanii CNS infections successfully treated with intraventricular colistin or aminoglycoside therapy with good tolerability. Additionally, recent pharmacokinetic analyses suggest improved cerebrospinal fluid (CSF) concentrations with direct CNS antimicrobial administration in combination with systemic therapy. Although our patient's cerebral spinal fluid cultures were cleared with dual intraventricular plus systemic therapy, she continued to deteriorate clinically because of her comorbid conditions and required hospice admission.
This describes the first reported case of KPC-producing K pneumoniae ventriculitis microbiologically cured based on negative blood and CSF cultures with a combination of intraventricular and systemic therapy.
报告 1 例产碳青霉烯酶肺炎克雷伯菌（KPC）的肺炎克雷伯菌脑室炎经双脑室加全身抗生素治疗成功的病例。
一名 43 岁女性，因脑室-腹腔分流术，从疗养院转入我院，伴有发热、精神状态改变和白细胞增多。她被发现患有产 KPC 的肺炎克雷伯菌脑室炎。联合应用脑室内抗生素黏菌素和庆大霉素联合全身黏菌素和阿米卡星治疗导致感染得到解决。
在文献中已经描述了多种耐药（MDR）革兰氏阴性中枢神经系统（CNS）感染的脑室内或鞘内抗生素的应用；然而，这些病例都不是由产 KPC 的病原体引起的。鉴于这种耐药病原体的致病性和有限的治疗选择，我们使用了脑室内黏菌素 10mg 和脑室内庆大霉素 10mg，联合全身黏菌素和阿米卡星。广泛的文献检索显示，有几例 MDR 鲍曼不动杆菌 CNS 感染的病例报告和病例系列，经脑室内黏菌素或氨基糖苷类治疗，具有良好的耐受性，取得了成功。此外，最近的药代动力学分析表明，直接给予 CNS 抗菌药物联合全身治疗可提高脑脊液（CSF）浓度。尽管我们的患者在双脑室加全身治疗后脑脊髓液培养物被清除，但由于她的合并症，她的临床状况继续恶化，需要入住临终关怀病房。
这是首例报道的产 KPC 的肺炎克雷伯菌脑室炎经脑室和全身联合治疗成功治愈的病例，依据是血和脑脊液培养物均转为阴性。
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