Abstract：
The treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3 rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient\'s treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41 st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68 th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case.
摘要：
由于抗菌选择有限和死亡率高，因此很难治疗耐碳青霉烯类肺炎克雷伯菌（CR-Kp）菌株引起的感染。关于CR-Kp引起颅内感染的报道很多,但CR-Kp引起的脑脓肿只有少数。这里,我们介绍了1例CR-Kp引起的脑脓肿用联合抗生素成功治疗。一名26岁的男性患者因高烧和头痛入院。他的既往病史包括因急性硬膜下血肿而进行的外科手术，在外部医疗中心进行。目前诊断为脑脓肿后，他接受了两次手术。在手术过程中,在超声引导下引流多个脑脓肿并进行囊切开术.开始美罗培南和万古霉素的组合。脓肿的内容物被送到微生物学和病理学实验室。在治疗的第3天，医疗团队被告知CR-Kp在脓肿培养中生长.患者改用美罗培南+粘菌素+替加环素治疗。患者在随访期间出现电解质紊乱，这被认为是粘菌素的不利影响。在治疗的第41天，粘菌素被停用,加入磷霉素,维持美罗培南和替加环素。在第68天停止治疗，当病人出院时。病人的一般情况，被跟踪了两年，是令人满意的。CR-Kp感染的治疗应个体化,在每种情况下都应考虑抗生素的药代动力学和药效学。
