successful treatment of carbapenem-resistant <i>klebsiella pneumoniae</i> meningitis with combination therapy of meropenem and amikacin

Introduction: the widespread use of carbapenems increased the prevalence of carbapenem-resistant enterobacteriaceaewith subsequent increases in mortality due to extremely limited treatment options. following neurosurgical procedures, carbapenem-resistant klebsiella pneumoniae(crkp) is the main cause of central nervous system (cns) infections. the optimal antimicrobial treatment of such infections has not yet been defined. case presentation: we present a 4-month-old boy with an extra-ventricular drain-related cns infection with crkp. although meropenem minimum inhibitory concentration (mic) for the bacterial isolate was ≥ 16 mg/l and it harbored blandm, blavim, and blaoxa-48-like carbapenemase genes, this infection was effectively treated with a combination therapy of intravenous (iv) double dose extended infusion of meropenem in addition to amikacin. conclusions: this successful treatment regimen for crkp-causing meningitis may pave the way to manage severe cns infections with extensive-drug-resistant bacteria in infants and children without inserting an external drain or intra-thecal antibiotic administration.