Cerebrospinal Fluid Exchange Combined with Intrathecal Antibiotic Injection for the Management of Severe Intracranial Infection Caused by Hypervirulent Klebsiella pneumoniae: A Case Report

Hong Wei,1 Lifan Xu,1 Lu Li,1 Yong Shen,1 Sijie Yu,2 Haiyan Huang,1 Xin Huang1 1Department of Emergency Medicine, Affiliated Lu’an Hospital of Anhui Medical University, Lu’an, Anhui, 237005, People’s Republic of China; 2Department of Critical Care Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei, 230001, People’s Republic of ChinaCorrespondence: Xin Huang, Department of Emergency Medicine, Affiliated Lu’an Hospital of Anhui Medical University, Lu’an, 237005, People’s Republic of China, Email [email protected]: Hypervirulent Klebsiella pneumoniae is a recently identified pathotype characterized by high virulence and rapid dissemination. It is associated with invasive infections at multiple anatomical sites, including liver abscesses, necrotizing fasciitis, meningitis, myositis, and endophthalmitis. It has emerged as a significant threat to public health due to its aggressive clinical course and high mortality rate. This case presents a 63-year-old female diabetic patient who developed lung abscess, liver abscess, and bacterial meningitis. Typical clinical manifestations confirmed through imaging, microbiological culture analysis, and whole-genome sequencing (ST65-K1) revealed Hypervirulent Klebsiella pneumoniae infection. The patient was comatose with purulent cerebrospinal fluid and obstructed drainage. Such severe cases of Hypervirulent Klebsiella pneumoniae intracranial infection are extremely rare. Early cerebrospinal fluid exchange, combined with intrathecal amikacin injection, was initiated. After one month of active treatment, the patient exhibited improved clinical outcomes and was subsequently discharged. This case highlights that patients with diabetes, particularly those presenting with high-risk comorbidities, are predisposed to developing triggering factors for Klebsiella pneumoniae invasive syndrome Klebsiella pneumoniae invasive syndrome. Early identification and implementation of individualized cerebrospinal fluid exchange therapy combined with intrathecal antibiotic therapy in critically ill meningitis patients infected with Klebsiella pneumoniae invasive syndrome are pivotal for improving prognosis. Collectively, these findings provide novel insights and a valuable framework for developing future therapeutically efficacious strategies for the management of Hypervirulent Klebsiella pneumoniae. However, this regimen does not standard-of-care, and further evidence is required to establish its safety and clinical effectiveness.Keywords: hypervirulent Klebsiella pneumoniae, intracranial infection, cerebrospinal fluid exchange, intrathecal injection, case report