Cure of recurring Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae septic shock episodes due to complicated soft tissue infection using a ceftazidime and avibactam-based regimen: a case report

• Published in: Journal of medical case reports Vol. 13; no. 1; p. 20
• Main Authors: Parruti, Giustino, Frattari, Antonella, Polilli, Ennio, Savini, Vincenzo, Sciacca, Antonina, Consorte, Augusta, Cibelli, Donatella Concetta, Agostinone, Adriana, Di Masi, Francesco, Pieri, Alessandro, Cacciatore, Pierluigi, Di Iorio, Giancarlo, Fazii, Paolo, Spina, Tullio
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22.01.2019; BioMed Central; BMC
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics; Azabicyclo Compounds - therapeutic use; Back pain; Beta lactamases; Care and treatment; Case Report; Case reports; Ceftazidime; Ceftazidime - therapeutic use; Cephalosporins; Device Removal; Dosage and administration; Drug Combinations; Drug Resistance, Multiple, Bacterial; Drug therapy; Enterobacteriaceae; Ethics; Evacuations & rescues; External Fixators - adverse effects; External Fixators - microbiology; Fracture Fixation; Fractures (Injuries); Hospitals; Humans; Infection; Infections; Infectious diseases; Klebsiella; Klebsiella Infections - drug therapy; Klebsiella Infections - microbiology; Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae; Male; Marketing; Medical ethics; Microbial drug resistance; Middle Aged; Mortality; Paralysis; Paraplegia; Patients; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - microbiology; Protease inhibitors; Risk factors; Sepsis; Septic shock; Shock; Shock, Septic - drug therapy; Skin; Soft Tissue Infections - drug therapy; Soft Tissue Infections - microbiology; Suicide; Tigecycline; Treatment; Treatment Outcome; Italy; Sepsis; Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae; Treatment
• DOI: 10.1186/s13256-018-1934-2
• ISSN: 1752-1947

Infections caused by multidrug-resistant Enterobacteriaceae are hard to treat and life-threatening due to reduced therapeutic options. Systemic infections caused by Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae strains have increased in many European regions, becoming frequent in many clinical settings, and are associated with high mortality. The co-formulation of ceftazidime, a third-generation cephalosporin, with avibactam, a new suicide inhibitor beta-lactamase inhibitor able to block most Klebsiella pneumoniae carbapenemases, has been recently licensed, with promising results in patients with limited or absent therapeutic options. Little is known, however, as to the efficacy of such a combination in patients with soft tissue infections caused by multidrug-resistant Klebsiella pneumoniae carbapenemase-producing strains of Klebsiella pneumoniae. A Caucasian 53-year-old man with paraplegia suffered multiple vertebral fractures due to a car crash. He was treated with external fixators that became infected early after insertion and were repeatedly and inefficiently treated with multiple antibiotics. He suffered repeated septic episodes caused by Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae strains with a multidrug-resistant profile. Meropenem, tigecycline, and colistin combinations allowed only temporary improvements, but septic shock episodes recurred, in spite of removal of infected external fixators. After approval of pre-marketing prescription by our local Ethics Committee, full clinical resolution was obtained with a compassionate treatment using meropenem and ceftazidime/avibactam in combination for 16 days. Our experience provides additional evidence that ceftazidime/avibactam, possibly in combination with meropenem rescued by avibactam, may be an efficacious treatment option also for complicated skin and soft tissue infections caused by multidrug-resistant strains of Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae.