Post-neurosurgical meningitis caused by KPC-producing Klebsiella pneumoniae: report of two cases

Abstract

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Whole-Genome Analysis of KPC-Producing Klebsiella Pneumoniae Isolates From Hospital Acquired Post-Neurosurgical Meningitis

“…Bacterial meningitis in hospitals, especially intracranial infections caused by bacteria which resistant to carbapenems, is a life-threatening complication in neurosurgery patients [20,21]. The most common pathogen of hospital-associated meningitis is Staphylococcus, and Gram-negative bacteria with multidrug resistance and extensive drug resistance, including Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae; CRKP is rarely isolated from CSF samples [12,13,22,23]. Nevertheless, in many countries, including Turkey, the United States and China, meningitis caused by CRKP neurosurgery has been reported [13,[23][24][25].…”

“…The most common pathogen of hospital-associated meningitis is Staphylococcus, and Gram-negative bacteria with multidrug resistance and extensive drug resistance, including Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae; CRKP is rarely isolated from CSF samples [12,13,22,23]. Nevertheless, in many countries, including Turkey, the United States and China, meningitis caused by CRKP neurosurgery has been reported [13,[23][24][25]. To our knowledge, this is the rst CRKP meningitis outbreak in cancer patients described in central China.…”

Treatment of Ventriculitis and Meningitis After Neurosurgery Caused by Carbapenem-Resistant Enterobacteriaceae (CRE): A Challenging Topic

“…Some case reports have also shown that polymyxin is effective in the treatment of CRE ventriculitis and meningitis. 54 , 55 In addition, some intracranial infections caused by CRE are sensitive to certain traditional antibiotics, such as amikacin 56 , 57 and gentamicin, 58 which have successfully saved the lives of some patients. According to retrospective studies, single use of tigecycline or polymyxin did not significantly increase mortality from pulmonary infection caused by CRE, while combination of drugs (carbapenem combined with polymyxin or tigecycline or gentamicin) reduced mortality.…”

“…But most cured intracranial CRE infection cases were used by multiple antibiotics. [55][56][57]60 In recent years, a new antibiotic ceftazidime-avibactam has been used in the clinical treatment of patients with CRE infection. Avibactam is a novel synthetic β-lactamase inhibitor that inhibits a wide range of β-lactamases, including Class A (KPC), and some Class D (OXA-48) β-lactamases and it does not inhibit Class B (IMP, VIM, VEB, and NDM) βlactamases.…”

Nosocomial meningitis caused by ESBL- and OXA-48-producing Klebsiella pneumoniae and treated with ceftazidime-avibactam. Report of one case and review of the literature

“…It was successfully treated with polymyxin and changing the shunt [ 24 ]. Other authors have reported cases of postsurgical meningitis due to carbapenem-resistant Enterobacteriaceae (CRE) that have been successfully treated combining tigecycline or polymyxin with intrathecal amikacin or colistin [ 25 - 26 ].…”