Case series; Ceftazidime/avibactam for treating post-neurosurgical ventriculitis and meningitis due to Carbapenem-resistant Klebsiella pneumonia (CRKP)

Objective: To share the treatment experience of patients with post neurosurgical ventriculitis and meningitis due to Carbapenem resistance Klebsiella pneumonia. Introduction: Post neurosurgical ventriculitis and meningitis due to Carbapenem resistance Klebsiella pneumonia is rare and extremely difficult to treat. Increasing resistance to the available antimicrobials has restricted the treatment strategies as a last resort or, unfortunately, none, sometimes. Materials and method: Data of patients with post neurosurgical ventriculitis due to Carbapenem resistance Klebsiella pneumonia were collected retrospectively. The isolated organisms were treated based on the sensitivity report of the cerebrospinal fluid analysis with intravenous and intraventricular antimicrobials. The outcome was assessed based on the clinical, imaging and lab parameters. Results: We identified eight patients (two females) with post neurosurgical ventriculitis and meningitis due to Carbapenem resistance Klebsiella pneumonia. Their age ranged from 6 to 65 years. The CSF analysis showed sensitivity to Colistin and newer antimicrobial Ceftazidime-Avibactam. Based on our prior experience, 5/8 patients were initially started on intravenous and intraventricular Colistin. Later, they were switched to intravenous Ceftazidime and Avibactam due to nonresponse to the initial combined intravenous and intraventricular Colistin therapy. The rest of the 3 patients were given straight IV Ceftazidime and Avibactam as a first-line antimicrobial following the sensitivity report. Though, patients showed improved responses to the newer combination of antimicrobial Ceftazidime and Avibactam; only 5/8 were cured. Conclusion: Intravenous CZA-AVI can be considered first line or as a sequential, targeted treatment to prior intravenous and intraventricular, colistin for post neurosurgical ventriculitis and meningitis due to Carbapenem resistance organisms.