Infection and Drug Resistance (Sep 2022)
Analysis of a Refractory Case of Pediatric Meningitis Caused by Klebsiella pneumoniae Co-Resistant to Carbapenems and Polymyxins
Abstract
Xu Huang,1 Mingxiao Han,2 Fei Jin,3 Zhichen Zhu,2 Haifang Zhang2 1Department of Clinical Laboratory, Children’s Hospital of Nanjing Medical University, Nanjing, People’s Republic of China; 2Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China; 3Department of Laboratory, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of ChinaCorrespondence: Haifang Zhang, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, People’s Republic of China, Tel +86 512 67783550 ; +86 18896808917, Email [email protected]: We report our clinical exploration experience treating a 6-year-old girl with a postoperative central nervous system (CNS) infection of prolonged invasion with Klebsiella pneumoniae (K. pneumoniae) co-resistant to carbapenems and polymyxin B. Although rational antibiotic therapy and effective source control measures were applied, the infection was not controlled eventually. To understand the mechanism of infection, whole-genome sequencing (WGS) was used to explore the resistance mechanism, and the susceptibility test was used to observe the efficacy of ceftazidime–avibactam (CAZ-AVI) in vitro. It is currently uncertain whether CAZ-AVI could be used as a salvage therapy for pediatric CNS infection. Therefore, we hope to share this case to seek medical help worldwide to treat pediatric CNS infection.Keywords: central nervous system, co-resistant to carbapenems and polymyxin B, Klebsiella pneumoniae, whole-genome sequencing, ceftazidime–avibactam