Combination of aztreonam, colistin and tigecycline in the treatment of neonatal carbapenemase-producing Enterobacteriaceae infection: a case report

The increased deployment of carbapenem antibiotics has led to a rise in carbapenem-resistant Enterobacter (CRE) prevalence. Notably, the incidence of CRE-related infections in neonatal intensive care units (NICUs) has surged, presenting significant clinical challenges. This case report emphasizes the treatment of neonatal CRE infections complicated by pneumonia and renal impairment and investigates the safety of tigecycline and polymyxin in pediatric settings. We conducted a retrospective analysis of clinical data from neonates with CRE-related pneumonia and renal impairment treated with a combination of tetracycline, polymyxin, and aztreonam. The case report assessed the risks and benefits of this regimen in managing neonatal infections and optimized the therapeutic protocol accordingly. In cases requiring invasive mechanical ventilation, infants exhibited enhanced respiratory mobility, managed spontaneous breathing, and showed occasional blood oxygen level fluctuations that normalized independently. Pulmonary ultrasound findings indicated a predominance of B-lines. The intervention controlled the infection effectively, leading to the infant's recovery and subsequent hospital discharge without significant adverse events. For neonates with CRE-related pneumonia and renal dysfunction, combining tetracycline and peptide antibiotics with other drugs effective against Escherichia coli, such as aminoglycosides, has shown to lower mortality rates associated with neonatal pneumonia caused by carbapenem-resistant Gram-negative bacteria. Our findings further elucidate CRE drug resistance mechanisms, antimicrobial selection, and pediatric safety for tetracyclines and peptides. Personalized combination therapy enhances treatment efficacy and minimizes adverse effects, particularly in cases involving drug-resistant bacterial infections.