Analysis of a Refractory Case of Pediatric Meningitis Caused by Klebsiella pneumoniae Co-Resistant to Carbapenems and Polymyxins

Abstract

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

Data Sharing Statement

The whole-genome sequence of K. pneumoniae 20JS63 was deposited in the GeneBank database (https://www.ncbi.nlm.nih.gov/genbank/) under accession number JAKEDZ000000000.

Disclosure

The authors report no conflict of interest in this work.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (82172332), the Science and Technology Development Fund of Nanjing Medical University (No. NMUB2018082), Gusu health youth talent of Suzhou (GSWS2019039, GSWS2020030), the Science and Technology Program of Suzhou (SKY2021007) and Discipline Construction of The Second Affiliated Hospital of Soochow University (XKTJ-TD202001).