Emergence of multiple antibiotic resistance during the therapy of Klebsiella pneumoniae meningitis.

A patient is described in whom multiple antibiotic resistance developed during the course of therapy of Klebsiella pneumoniae meningitis. Sequential resistance developed to chloramphenicol, gentamicin and eventually amikacin. As previously reported, the use of the chloramphenicol alone in the therapy of gram-negative bacillary meningitis can result in rapid emergence of resistance and treatment failure. In this patient, the subsequent emergence of gentamicin and amikacin resistance may have been related to the omission of intrathecal aminoglycoside. A short review of the literature is presented and recommendations are made for the therapy of gram-negative bacillary meningitis.