Successful treatment of ceftazidime-resistant Klebsiella pneumoniae ventriculitis with intravenous meropenem and intraventricular polymyxin B: Case report and review

Increasing prevalence of multidrug-resistant gram-negative organisms has le d to a rise in clinically significant infections with these organisms and a n increasing therapeutic dilemma. We present a case of a neurosurgical pati ent who developed ventriculoperitoneal shunt-associated ventriculitis due t o ceftazidime-resistant Klebsiella pneumoniae susceptible to cefepime, imip enem, meropenem, and polymyxin B only. Successful management was accomplish ed by removal of the shunt and therapy with systemic meropenem and intraven tricular polymyxin B. Rapid cerebrospinal fluid (CSF) sterilization occurre d, with CSF bactericidal titers of 1:32 to 1:128. Polymyxin B should be con sidered 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.