Intrathecal or Intraventricular Tigecycline Therapy for Central Nervous System Infection Associated with Carbapenem-Resistant Klebsiella pneumoniae

Ning Du; En-Qiang Mao; Zhi-Tao Yang; Hong-Ping Qu; Xian Qian; Ying Shi; Xiao-Lan Bian; Juan He; Er-Zhen Chen

doi:10.2147/IDR.S387346

Intrathecal or Intraventricular Tigecycline Therapy for Central Nervous System Infection Associated with Carbapenem-Resistant Klebsiella pneumoniae

Infect Drug Resist. 2022 Dec 9:15:7219-7226. doi: 10.2147/IDR.S387346. eCollection 2022.

Authors

Ning Du¹, En-Qiang Mao², Zhi-Tao Yang², Hong-Ping Qu³, Xian Qian⁴, Ying Shi⁵, Xiao-Lan Bian⁶, Juan He^#⁶, Er-Zhen Chen^#²

Affiliations

¹ National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, People's Republic of China.
² Emergency Intensive Care Unit, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
³ Department of Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
⁴ Department of Pharmacy, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, People's Republic of China.
⁵ Department of Clinical Pharmacy, Shaoxing Hospital of Traditional Chinese Medicine, Zhejiang, People's Republic of China.
⁶ Department of Pharmacy, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Infection with carbapenem-resistant Klebsiella pneumoniae (CRKP) is a great challenge. Central nervous system (CNS) infection caused by CRKP is rarely reported, and effective treatment is limited. Thus, this study aimed to assess intrathecal (IT) or intraventricular (IVT) injection of tigecycline for clearing infection with CRKP in CNS.

Patients and methods: Two patients who had intracranial infection with CRKP after craniotomy were treated in our institution and analyzed retrospectively, summarizing their therapeutic schedules.

Results: They all had a fever with the positive results of cerebrospinal fluid (CSF) test, and CSF culture showed positive for CPKP, which was sensitive only to tigecycline. In addition, the MIC of polymyxin B was not tested due to the limited laboratory conditions. After IT or IVT injection of tigecycline treatment, the temperature of the patients became normal in 3 days, with normal levels of white blood cells, protein, glucose and chlorine concentrations in the CSF. Crucially, twice CSF cultures also became negative with no clinical symptoms of intracranial infection after IT or IVT injection of tigecycline treatment. Moreover, there were no adverse drug reactions observed.

Conclusion: IT or IVT injection of tigecycline may be a bright choice to control intracranial infection with CRKP.

Keywords: CNS; CRKP; carbapenem-resistant Klebsiella pneumoniae; central nervous system infection; tigecycline; treatment.

Publication types

Case Reports

Grants and funding

This study was supported by the National Natural Science Foundation of China (Grant No. 81772107 and 81571931). This study was also funded by the Important and weak discipline construction plan for health and family planning system of Shanghai (No.2016ZB0206), and Project of three-year plan to promote clinical skills and innovation ability of Municipal Hospitals (No.SHDC2020CR1028B).