Post-neurosurgical meningitis caused by KPC-producing Klebsiella pneumoniae: report of two cases

Yasmin Coelho Patrial Luma Petri Tortorelli Ana Claudia Souza Rodrigues Ivson Cassiano de Oliveira Santos Cláudia Elizabeth Volpe-Chaves Gislaine Souza Capato Gustavo Augusto Ribeiro Barbosa Ana Paula D’Alincourt Carvalho-Assef Marilene Rodrigues Chang About the authors

ABSTRACT

Nosocomial bacterial infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) is associated with high mortality in neurosurgical patients. There are few reports in the literature on meningitis caused by CRKP. We report two cases of CRKP meningitis after neurosurgery. The K. pneumoniae identification and antimicrobial susceptibility testing were performed using the Vitek Compact System. Minimum inhibitory concentrations of polymyxin B were determined using the broth microdilution method. Molecular typing of K. pneumoniae isolates was investigated using multilocus sequence typing. Antimicrobial susceptibility testing showed that the K. pneumoniae isolates were multidrug resistant and co-produced extended-spectrum β-lactamases and KPC enzymes. The patients were treated with intrathecal polymyxin. Genetic polymorphism analyses revealed two different K. pneumoniae clones (ST1298 and ST2687), which were observed for the first time in CRKP infections. We recommend intravenous administration of intrathecal polymyxin for treating meningitis caused by multidrug-resistant K. pneumoniae .

Meningitis; Klebsiella pneumoniae; Carbapenem-resistant; Beta-lactamases; Cerebrospinal fluid

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