A successful individualized comprehensive therapy for carbapenem-resistant Klebsiella pneumoniae induced multifocal brain abscesses: a case report and literature review

Carbapenem-resistant Klebsiella pneumoniae (CRKP)-induced brain abscess is an exceedingly rare disease. We presented the fourth case of CRKP-induced brain abscess but the first multifocal and most complicated one accompanied by intracranial Epstein-Barr virus detection positive. The patient was treated with a regime of intravenous ceftazidime/avibactam combined with intrathecal colistimethate sodium. To our knowledge, this represented the first reported application of such a regimen for a CRKP-induced brain abscess. When the abscess formed an intact envelope, the patient underwent craniotomy for resection. Postoperatively, the antibiotic regimen was continued for 2 weeks until the CSF examination became nearly normal. The patient remained asymptomatic over the next 12 months follow-up without recurrences. This case highlights the rarity of CRKP-induced brain abscess and provides a novel combination of antibiotic regimen, which also emphasizes the necessity for individualized and comprehensive therapeutic strategy.