A challenging case of carbapenemase-producing Klebsiella pneumoniae septic thrombophlebitis and right mural endocarditis successfully treated with ceftazidime/avibactam
A challenging case of carbapenemase-producing Klebsiella pneumoniae septic thrombophlebitis and right mural endocarditis successfully treated with ceftazidime/avibactam
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DOI：
10.1007/s15010-018-1166-9
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发表时间：
2018-10-01
期刊：
影响因子：
7.5
通讯作者：
Venditti, Mario
中科院分区：
文献类型：
--
作者：
Iacovelli, Alessandra;Spaziante, Martina;Venditti, Mario
简介产生碳青霉烯酶的肺炎克雷伯菌（KPC-Kp）的出现已成为南欧许多医院公共卫生和临床结果方面的一个重大问题。治疗选择通常有限，有效治疗这些病原体引起的感染对临床医生来说是一个巨大的挑战。头孢他啶-阿维巴坦最近被批准用于治疗治疗选择有限的患者中需氧革兰氏阴性菌引起的难治性感染。 病例报告我们报告了第一例与转移性肺脓肿相关的 KPC-Kp 化脓性血栓性静脉炎和右心房心内膜炎，通过延长头孢他啶/阿维巴坦加厄他培南疗程成功治疗，表明这种联合疗法对于严重的重症患者可能是安全有效的革兰氏阴性菌感染。有趣的是，我们还观察到临床和微生物学过程之间存在明显差异：患者迅速发热；血流动力学稳定，降钙素原水平呈迅速下降趋势。然而，血培养在较长时间内持续呈阳性。 结论 总之，头孢他啶-阿维巴坦联合厄他培南是治疗 KPC-Kp 引起的严重血管内感染的安全有效的方法。此外，在这种情况下，后续血培养可能是指导治疗的不可替代的工具。
IntroductionThe emergence of carbapenemase-producing Klebsiella pneumonia (KPC-Kp) has become a significant problem in terms of public health and clinical outcome in many hospitals in Southern Europe. Treatment options are usually limited and effective treatment of infections caused by these pathogens is a considerable challenge for clinicians. Ceftazidime-avibactam has been recently approved for the treatment of difficult-to-treat infections due to aerobic Gram-negative organisms in patients with limited treatment options.Case reportWe reported the first case of KPC-Kp septic thrombophlebitis and right atrial endocarditis associated with metastatic lung abscesses successfully treated with a prolonged ceftazidime/avibactam plus ertapenem treatment course, suggesting that this combination therapy could be safe and effective for serious Gram-negative infections. Interestingly, we also observed an apparent discrepancy between clinical and microbiological courses: the patient became rapidly afebrile; hemodynamically stable and his procalcitonin levels showed a prompt decreasing trend. Nevertheless, blood cultures remained persistently positive for a prolonged period.ConclusionIn conclusion, ceftazidime-avibactam plus ertapenem was a safe and effective therapy of serious endovascular infection due to KPC-Kp. Moreover, in this setting, follow-up blood cultures might represent an irreplaceable tool to guide the therapy.