Journal Article

Successful Treatment of Ceftazidime-Resistant <i>Klebsiella pneumoniae</i> Ventriculitis with Intravenous Meropenem and Intraventricular Polymyxin B: Case Report and Review

Sorana Segal-Maurer, Noriel Mariano, Abdul Qavi, Carl Urban and James J. Rahal

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 28, issue 5, pages 1134-1138
Published in print May 1999 | ISSN: 1058-4838
Published online May 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/514754
Successful Treatment of Ceftazidime-Resistant Klebsiella pneumoniae Ventriculitis with Intravenous Meropenem and Intraventricular Polymyxin B: Case Report and Review

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Increasing prevalence of multidrug-resistant gram-negative organisms has led to a rise in clinically significant infections with these organisms and an increasing therapeutic dilemma. We present a case of a neurosurgical patient who developed ventriculoperitoneal shunt-associated ventriculitis due to ceftazidime-resistant Klebsiella pneumoniae susceptible to cefepime, imipenem, meropenem, and polymyxin B only. Successful management was accomplished by removal of the shunt and therapy with systemic meropenem and intraventricular polymyxin B. Rapid cerebrospinal fluid (CSF) sterilization occurred, with CSF bactericidal titers of 1:32 to 1:128. Polymyxin B should be considered as adjunctive therapy for life-threatening multidrug-resistant gram-negative infections. Prior literature on use of intrathecal polymyxin B in therapy for meningitis supports its potential efficacy.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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