• Jiyao Li, Yiguo Liu, Guangtao Wu, Hongyan Wang, and Xiaoyan Xu.
• Department of Pharmacy, Liaocheng People's Hospital, Liaocheng, China.
• Medicine (Baltimore). 2022 Jul 29; 101 (30): e29635e29635.

RationaleCentral nervous system infections (CNSIs) are one of the most serious complications after neurosurgery, especially carbapenem-resistant bacterial meningitis. Owing to the poor blood-brain barrier permeability of most antibiotics, the treatment of CNSIs by intraventricular (IVT) administration is becoming a hot topic in clinical research. Currently, the treatment of CNSIs caused by carbapenem-resistant Klebsiella pneumoniae is mainly based on intraventricular injection of an antibiotic combined with one or more other systemic intravenous (IV) antibiotics, whereas there are few case reports of intraventricular injection of 2 antibiotics.Patient ConcernsA 57-year-old man with an open craniocerebral injury presented with dyspnea, high fever, and seizures associated with surgery.DiagnosisIntracranial infection caused by carbapenem-resistant K. pneumoniae was diagnosed.InterventionsOn the advice of a clinical pharmacist, the patient was given tigecycline (100 mg IV + 3 mg IVT q12h) combined with amikacin (0.8 g IV + 30 mg IVT qd) antiinfective therapy. Ultimately, the pathogens in the cerebrospinal fluid were eradicated after 7 days, and the CNSIs were completely cured after 14 days.OutcomesThe patient recovered and was discharged from the hospital without adverse reactions.LessonsA series of in vitro and in vivo synergy tests of carbapenem-resistant K. pneumoniae showed that tigecycline combined with aminoglycosides had good synergistic effects and effectively suppressed bacterial resistance selection. Intravenous plus intraventricular tigecycline-amikacin seems to be a safe and effective treatment option for carbapenem-resistant K. pneumoniae CNSIs.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

35 keywords...

hide…