Lumbar arthrodesis infection by multi-resistant Klebsiella pneumoniae, successfully treated with implant retention and ceftazidime/avibactam

Ceftazidime-Avibactam for the Treatment of Serious Gram-Negative Infections with Limited Treatment Options: A Systematic Literature Review

“…On day 50, patient was readmitted and cultures showed an increase in ceftazidime-avibactam MIC from 1 to 3 mg/l Räisänen 2019 [ 85 ] Patient in Finland (age/sex NR) transferred from a hospital in Greece who had been colonised with blaKPC-2-producing K. pneumoniae ST39 Bacteraemia developed 16 days after initial infection Yes K. pneumoniae (KPC-2, ST39) Dose NR, 34 days before resistance identified Patient recovered from the infection following discontinuation of ceftazidime-avibactam and subsequent 12 days administration of sulfamethoxazole-trimethoprim and colistin Ceftazidime-avibactam resistance was observed after 34 days of treatment. The strain isolated after ceftazidime-avibactam treatment had a mutated blaKPC-2 gene encoding KPC-2 protein with 15 amino acid insertion; the observed mutation in blaKPC-2 gene has not been described previously Rico-Nieto 2018 [ 86 ] 29-year-old female with infection of a lumbar instrumentation No K. pneumoniae (OXA-48) 2.5 g q8h, 8 weeks The patient improved clinically after 8 weeks and without toxicity. After 1 year, she remained stable and without further infection or need for surgery.…”

Multidisciplinary Approach to Multiple Multiresistant Agent Infection of Instrumented Spine Surgery

“…S urgical wound infection is a rare but serious complication of lumbar spine surgery, with approximately one-third of the cases being attributable to gram-negative pathogens, a percentage that increases because lower levels of the spine are involved 20 . Data on the treatment of spinal infections by CRKP are limited but have increased in recent years, although to the best of our knowledge, only 4 cases have been reported so far [21][22][23][24] . These resort to combination antibiotic therapies, including the novel CAZ-AVI, a third-generation cephalosporin with a non-beta-lactam beta-lactamase inhibitor (NBLBLI) with proven activity against CRKP, with successful results [21][22][23][24] .…”

“…Data on the treatment of spinal infections by CRKP are limited but have increased in recent years, although to the best of our knowledge, only 4 cases have been reported so far [21][22][23][24] . These resort to combination antibiotic therapies, including the novel CAZ-AVI, a third-generation cephalosporin with a non-beta-lactam beta-lactamase inhibitor (NBLBLI) with proven activity against CRKP, with successful results [21][22][23][24] . Several other clinical studies support this compound's efficacy and ideal dosing [25][26][27] .…”

Antibacterial Designs for Implantable Medical Devices: Evolutions and Challenges

“…Antibiotic resistance in bacteria even multidrug-resistant (MDR) bacteria is now a worldwide challenge [ 91 ]. Antibiotic-resistant infections were frequently reported all over the world, including in both developing and developed countries ( Table 4 ) [ 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ]. During an infection, Staphylococcus aureus ( S. aureus ) often forms biofilms on implantable devices, which dramatically increases the ability of the species to acquire resistance via horizontal plasmid transfer [ 111 ].…”

“…As shown by the typical cases reported in recent years ( Table 4 ), MRSA has become the most common strain causing infections of various implantable medical devices, including cardiac devices [ 93 , 95 , 99 , 103 , 106 ], orthopedic prosthetics [ 96 , 97 ], cochlear implants [ 98 ], breast implants [ 100 ], laryngeal implants [ 101 ], and stent grafts [ 109 ]. In addition, there is an alarming increase in antibiotic resistance in other strains, such as Acinetobacter baumannii [ 92 ], Mycobacterium chelonae [ 94 ], Enterobacter cloacae complex [ 102 ], S. epidermidis [ 104 , 110 ], Klebsiella pneumoniae [ 105 ], Staphylococcus haemolyticus [ 107 ], and Staphylococcal endophthalmitis [ 108 ], are also involved in various resistant DAIs. Those resistant DAIs impacted patients have to experience prolonged hospital stays, bear high medical costs, and risk increased mortality (references in Table 4 ).…”