The 2017 Garrod Lecture: Genes, guts and globalization

A Case Report of Invasive Klebsiella pneumoniae Liver Abscess Syndrome Treated with Ceftazidime-Avibactam in Combination with Meropenem

Introduction

The emergence of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) presents a formidable challenge to public health and clinical medicine. This dual phenotype of hypervirulence and multi-drug resistance often complicates treatment options, leaving patients with limited antimicrobial regimens. Consequently, adverse clinical outcomes and high mortality rates are common. Ceftazidime-avibactam (CAZ-AVI) is recognized globally as a critical option for treating infections caused by resistant gram-negative bacteria.

Case Report

We present a case of invasive Klebsiella pneumoniae liver abscess syndrome caused by a CR-hvKP infection. The patient exhibited a bloodstream infection, lung and liver abscesses, and suppurative meningitis, eventually developing a brain abscess. Treatment with a combination of meropenem and CAZ-AVI led to a favorable clinical outcome.

Conclusion

This case report indicates that combining CAZ-AVI with an antimicrobial agent that is in vitro non-susceptible (carbapenems in this case) is safe and effective for treating severe, multi-site infections caused by CR-hvKP, including central nervous system infections. This case serves as a clinical reference for managing similar patients in practice.

Novel Siwa propolis and colistin-integrated chitosan nanoparticles: elaboration; in vitro and in vivo appraisal

Aim: The present study aimed to formulate novel cremophore-decorated chitosan nanoparticles of colistin, integrated with Siwa propolis extract, to solve bacterial resistance to colistin. Materials & methods: The novel nanoformula was prepared using an incorporation method. Physicochemical assessment and in vivo studies of the selected nanoformulations were performed. Results: The nanoformulation exhibited a nanosize of 48.3 nm, high ζ potential (43.6 mV), high entrapment efficiency (75%) and complete bacterial growth eradication within 2 h (minimum inhibitory concentration = 6.25 μg/ml). Histological examination showed that incorporation of colistin into the nanoformulation could successfully prevent its nephrotoxicity. Conclusion: Tailoring of proper nanocarrier could successfully revert bacteria from being colistin-resistant to colistin-sensitive. The developed nanoformulation can be considered as a potential antibacterial agent in pneumonia treatment.