Treatment of Post-Neurosurgical Ventriculitis and Scalp Infection Caused by Klebsiella pneumoniae Carbapenemase and New Delhi Metallo-β-Lactamase Co-Producing Carbapenem-Resistant Klebsiella pneumoniae: A Case Report

The treatment of intracranial infections caused by Klebsiella pneumoniae carbapenemase and New Delhi metallo-β-lactamase coproducing carbapenem-resistant Klebsiella pneumoniae is extremely limited. The blood-brain barrier severely restricts the penetration of most systemically administered antibiotics, and robust pharmacokinetic/pharmacodynamic data for novel agents in the central nervous system remain scarce. Therefore, identifying effective therapeutic strategies is critical. We report a study of a 36-year-old Han Chinese male treated with meropenem-vaborbactam and aztreonam in the case of post-neurosurgical ventriculitis and scalp infection caused by Klebsiella pneumoniae carbapenemase and New Delhi metallo-β-lactamase co-producing carbapenem-resistant Klebsiella pneumoniae. Meanwhile, we also examined the plasma and cerebrospinal fluid concentrations of meropenem-vaborbactam at 0, 1, 2, 3, 5, and 8 h over a complete dosing interval. Pharmacokinetic analysis was as follows: for meropenem and vaborbactam, the plasma concentrations were 0.75-36.33 mg/L and 4.57-94.71 mg/L, respectively, while those in cerebrospinal fluid ranged from 1.04 to 4.66 mg/L and 3.29 to 16.11 mg/L, respectively. Calculated cerebrospinal fluid penetration reached 19.0% for meropenem and 21.2% for vaborbactam. This work further emphasizes the significance of therapeutic drug monitoring in clinical practice in order to optimize antibiotic therapy in severe infections.