Abstract：
A man in his 40s with type 2 diabetes mellitus had persistent right-sided watery nasal discharge for 6 months following cerebrospinal fluid (CSF) leak repair at another hospital, prompting his visit to us due to recurring symptoms. Imaging revealed a CSF leak from the mid-clivus for which revision endoscopic CSF leak repair was done. Regrettably, he developed postoperative meningitis caused by multidrug-resistant (MDR) Klebsiella pneumoniaeManaging this complex case was a challenging task due to the pathogen\'s resistance to conventional drugs and the scarcity of scientific evidence. We initiated a culture-guided combination regimen with ceftazidime, avibactam, aztreonam and tigecycline. This decision stemmed from meticulous literature review and observed antibiotic synergy while testing for this organism.After 4 weeks of vigilant treatment, the patient\'s symptoms improved significantly, and CSF cultures were sterile. We present our approach to effectively confront and manage a challenging instance of postoperative MDR bacterial meningitis.
摘要：
一名40多岁的2型糖尿病患者在另一家医院进行脑脊液（CSF）渗漏修复后，持续存在6个月的右侧水样鼻涕，由于反复出现的症状，促使他来我们这里。影像学检查显示，中斜坡的CSF泄漏已进行了内窥镜内窥镜CSF泄漏修复。遗憾的是,他出现了由多重耐药(MDR)肺炎克雷伯菌引起的术后脑膜炎。由于病原体对常规药物的耐药性和缺乏科学证据,因此处理这一复杂病例是一项具有挑战性的任务。我们启动了头孢他啶的文化指导联合治疗方案，阿维巴坦,氨曲南和替加环素.这一决定源于细致的文献综述，并在测试该生物体时观察到抗生素协同作用。经过4周的警惕治疗，患者的症状明显改善，和CSF培养物是无菌的。我们提出了有效应对和管理术后MDR细菌性脑膜炎的挑战性实例的方法。
