Pharmacodynamic target attainment at infection site during treatment of post-neurosurgical ventriculitis caused by carbapenem-resistant klebsiella pneumoniae with ceftazidime-avibactam-based regimens: a case report

Yinru Chen; Wanzhen Li; Xiaofen Liu; Yan Chen; Jing Zhang; Nanyang Li; Lei Yang

doi:10.1016/j.ijantimicag.2024.107356

Pharmacodynamic target attainment at infection site during treatment of post-neurosurgical ventriculitis caused by carbapenem-resistant klebsiella pneumoniae with ceftazidime-avibactam-based regimens: a case report

Int J Antimicrob Agents. 2024 Dec;64(6):107356. doi: 10.1016/j.ijantimicag.2024.107356. Epub 2024 Oct 9.

Authors

Yinru Chen¹, Wanzhen Li², Xiaofen Liu², Yan Chen², Jing Zhang³, Nanyang Li⁴, Lei Yang⁵

Affiliations

¹ Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; School of Pharmacy, Fudan University, Shanghai, China.
² Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
³ Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; Clinical Pharmacology Research Center, Huashan Hospital, Fudan University, Shanghai, China.
⁴ Clinical Pharmacology Research Center, Huashan Hospital, Fudan University, Shanghai, China. Electronic address: linanyang1213@163.com.
⁵ Department of Neurosurgery & Neurocritical Care, Huashan Hospital, Fudan University, Shanghai, China. Electronic address: leiyangdr@163.com.

PMID: 39389386
DOI: 10.1016/j.ijantimicag.2024.107356

Abstract

A patient developed a post-neurosurgical ventriculitis with carbapenem-resistant Klebsiella pneumoniae and mold, initially treated with ceftazidime/avibactam and voriconazole. A Klebsiella pneumoniae carbapenemase mutation led to therapy adjustment to ceftazidime/avibactam and polymyxin B, achieving cure. Pharmacokinetic/pharmacodynamic analysis highlights effective ceftazidime/avibactam brain penetration and bacterial clearance efficacy.

Keywords: Carbapenem-resistant Klebsiella pneumoniae; Ceftazidime-avibactam; Central nervous system infection; Pharmacodynamics; Pharmacokinetics; Polymyxin B.

Publication types

Case Reports

MeSH terms

Anti-Bacterial Agents* / pharmacology
Anti-Bacterial Agents* / therapeutic use
Azabicyclo Compounds* / pharmacology
Azabicyclo Compounds* / therapeutic use
Bacterial Proteins / genetics
Carbapenem-Resistant Enterobacteriaceae / drug effects
Carbapenem-Resistant Enterobacteriaceae / genetics
Ceftazidime* / pharmacology
Ceftazidime* / therapeutic use
Cerebral Ventriculitis* / drug therapy
Cerebral Ventriculitis* / microbiology
Drug Combinations*
Female
Humans
Klebsiella Infections* / drug therapy
Klebsiella Infections* / microbiology
Klebsiella pneumoniae* / drug effects
Klebsiella pneumoniae* / genetics
Male
Microbial Sensitivity Tests
Middle Aged
Polymyxin B / pharmacology
Polymyxin B / therapeutic use
beta-Lactamases / genetics
beta-Lactamases / metabolism

Substances

Azabicyclo Compounds
Ceftazidime
avibactam, ceftazidime drug combination
Drug Combinations
Anti-Bacterial Agents
Bacterial Proteins
beta-Lactamases
carbapenemase
Polymyxin B