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.

Abstract

The infections caused by carbapenemase-producing Klebsiella pneumoniae (CPKP) have limited treatment options, [13]; this implies an even worse problem if the infection is located in the central nervous system (CNS), due to the limited blood-brain barrier (BBB) penetration of the antibiotics and, therefore, the need for higher doses. There is scarce evidence regarding the optimal dose and the cerebrospinal fluid (CSF) concentration of most new antibiotics used for the treatment of CPKP, including OXA-48-producing K. pneumoniae. CAZ-AVI is a new beta-lactam combined with extended-spectrum beta-lactamase (ESBL) inhibitor against Gram-negative bacilli (GNB), both fermenters and non-fermenters [2,4], whose action spectrum include Ambler class A (KPC), class D (OXA-48), and many class C (Amp-C) CPKP [5-9]. Thus, it constitutes the first therapeutic option in CPKP-triggered infections that are not located in the urinary tract [10].