Spinal epidural abscess caused by a community acquired extended spectrum beta lactamase producing Klebsiella pneumonia

Abstract

Spinal epidural abscess (SEA) can be a medical and surgical emergency. It is encountered in patients with epidural catheter placement, paraspinal injections, diabetes mellitus, alcoholism, HIV infection, trauma, contiguous bony or soft tissue infection, intravenous drug use, hemodialysis, or overt bacteremia, but may occur spontaneously associated with a presumed silent bacteremia. We report here, a case of extensive SEA due to a community-acquired extended spectrum beta lactamase (ESBL)-producing Klebsiella pneumoniae in a diabetic patient. This case highlights the importance of stringent antimicrobial stewardship and also the need for prompt diagnostic evaluation, and early surgical decompression in order to prevent morbidity and mortality.

Fatal Cervical Spinal Epidural Abscess and Spondylodiscitis Complicated With Rhombencephalitis Caused by Klebsiella pneumoniae: A Case Report and Literature Review

“…One-half of the patients presented with diabetes mellitus. The lumbar and thoracic spine are the major affected spinal levels; in contrast, only a few reports have described cervical SEA caused by K. pneumoniae as in the present case [9,13]. According to the clinical manifestations, this patient presented atypical features consisting of fever, neck mass, and painful swallowing with a lack of neurological deficit on admission.…”

“…Among gram-negative SEA and spondylodiscitis, promptly combined therapy of both surgical drainage and antimicrobial therapy remains crucial [11]. Eight of 10 patients with K. pneumoniae SEA from related reports encountered favorable outcomes after combined surgical and medical therapy [7][8][9][10]13,14]. However, only two cases recovered after being conservatively treated with antibiotics [6,11].…”

“…Klebsiella pneumoniae are the family members of Enterobacterales, which are capable of causing various types of community-acquired and healthcare-associated infection (HAI), e.g., pneumonia, internal organ abscess, and bacteremia [5]. Currently, few cases have been reported with isolated and spontaneous K. pneumoniae SEA [6][7][8][9][10][11][12][13][14]. Here, we report the case of fatal isolate and spontaneous K. pneumoniae spondylodiscitis and SEA involving C1-C7 complicated with rhombencephalitis in a patient with diabetes.…”

Pyogenic spondylodiscitis in HIV-positive patients under antiretroviral therapy: A case series

“…Patient 5, a man who has sex with men (MSM), presented twice with uncommon infections of the lumbar discs: Klebsiella pneumoniae was cultured from both blood and disc L4/5 during his first episode of spondylodiscitis. There are few case reports of Klebsiella pneumoniae causing spondylodiscitis, for example in association with urinary tract infection 19 or liver abscess 20 in Asian populations, where hypervirulent Klebsiella pneumonia could cause more metastatic spread of infection. 21 In our patient the infection was spontaneous, which has recently also been described in a Japanese and a Thai male.…”