TREATMENT OF A MENINGITIS DUE TO AN ENTEROBACTER-AEROGENES PRODUCING A DEREPRESSED CEPHALOSPORINASE AND A KLEBSIELLA PNEUMONIAE PRODUCING AN EXTENDED-SPECTRUM BETA-LACTAMASE

A case of nosocomial meningitis due to a Klebsiella pneumoniae producing a CAZ-5 extended-spectrum beta-lactamase and an Enterobacter aerogenes producing a depressed cephalosporinase is reported. The intrathecal catheter incriminated was removed and a treatment with ceftazidime (4 g/24 h) and amikacin (1.5 g/24 h) was started. After 24 h ceftazidime was replaced by imipenem (2 then 4 g/24 h). This treatment failed to obtain cerebrospinal fluid sterilization; therefore the imipenem dosage was increased to 8 g/24 h and two intrathecal infusions of amikacin (50 mg) were carried out. Thereafter the patient recovered.