Namik Kemal University , Faculty of Medicine , Department of Neurosurgery , Tekirdag , Turkey.
Namik Kemal University , Faculty of Medicine , Department of Infectious Diseases , Tekirdag , Turkey.
Rev Inst Med Trop Sao Paulo. 2023 Mar 24;65:e23. doi: 10.1590/S1678-9946202365023. eCollection 2023.
The treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3 rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient's treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41 st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68 th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case.
由于抗菌药物选择有限且死亡率高，治疗碳青霉烯类耐药肺炎克雷伯菌（CR-Kp）引起的感染较为困难。有许多关于 CR-Kp 引起的颅内感染的报道，但只有少数关于 CR-Kp 引起的脑脓肿的报道。在这里，我们报告了一例成功用联合抗生素治疗的 CR-Kp 引起的脑脓肿。一名 26 岁男性患者因高热和头痛被收入我院。他的既往病史包括在外院行急性硬膜下血肿手术。目前诊断为脑脓肿后，他接受了两次手术。在手术过程中，在超声引导下行多个脑脓肿引流和囊切开术。开始使用美罗培南和万古霉素联合治疗。脓肿内容物被送到微生物和病理实验室。治疗第 3 天，医生被告知脓肿培养物中生长出 CR-Kp。患者的治疗方案更改为美罗培南+多粘菌素 E+替加环素。在随访过程中，患者出现电解质紊乱，这被认为是多粘菌素 E 的不良反应。治疗第 41 天，停用多粘菌素 E，加用磷霉素，保留美罗培南和替加环素。治疗第 68 天，当患者出院时停止使用。患者在随访 2 年后一般状况良好。CR-Kp 感染的治疗应个体化，应考虑每种情况下抗生素的药代动力学和药效学。
