Yang Mengying, Wang Baogui
Department of Infectious Disease, Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, Anhui, 236000, People's Republic of China.
Infect Drug Resist. 2024 Sep 25;17:4161-4165. doi: 10.2147/IDR.S480665. eCollection 2024.
The emergence of carbapenem-resistant hypervirulent (CR-hvKP) presents a formidable challenge to public health and clinical medicine. This dual phenotype of hypervirulence and multi-drug resistance often complicates treatment options, leaving patients with limited antimicrobial regimens. Consequently, adverse clinical outcomes and high mortality rates are common. Ceftazidime-avibactam (CAZ-AVI) is recognized globally as a critical option for treating infections caused by resistant gram-negative bacteria.
We present a case of invasive liver abscess syndrome caused by a CR-hvKP infection. The patient exhibited a bloodstream infection, lung and liver abscesses, and suppurative meningitis, eventually developing a brain abscess. Treatment with a combination of meropenem and CAZ-AVI led to a favorable clinical outcome.
This case report indicates that combining CAZ-AVI with an antimicrobial agent that is in vitro non-susceptible (carbapenems in this case) is safe and effective for treating severe, multi-site infections caused by CR-hvKP, including central nervous system infections. This case serves as a clinical reference for managing similar patients in practice.
耐碳青霉烯类高毒力肺炎克雷伯菌（CR-hvKP）的出现给公共卫生和临床医学带来了巨大挑战。这种高毒力和多重耐药的双重表型常常使治疗选择变得复杂，留给患者的抗菌治疗方案有限。因此，不良的临床结局和高死亡率很常见。头孢他啶-阿维巴坦（CAZ-AVI）在全球被公认为治疗由耐药革兰氏阴性菌引起的感染的关键选择。
我们报告一例由CR-hvKP感染引起的侵袭性肝脓肿综合征病例。患者出现血流感染、肺和肝脓肿以及化脓性脑膜炎，最终发展为脑脓肿。美罗培南和CAZ-AVI联合治疗取得了良好的临床效果。
本病例报告表明，将CAZ-AVI与体外不敏感的抗菌药物（本病例中为碳青霉烯类）联合使用，对于治疗由CR-hvKP引起的严重多部位感染（包括中枢神经系统感染）是安全有效的。该病例为实际临床中管理类似患者提供了参考。
