Intraabdominal Infection Caused by Extremely Drug-Resistant Klebsiella pneumoniae Successfully Treated with Ceftazidime/Avibactam in Combination with Aztreonam: The First Case Report in Thailand

A 54-year-old Bangladesh female was referred to a Thai private hospital for management of her serious illness. She was found to have intraabdominal infection from perforation at the second part of the duodenum and the right sided empyema. The initial pleural fluid culture from Bangladesh grew Klebsiella pneumoniae, which was susceptible only to tigecycline. She underwent laparoscopy and drainage of intraabdominal collection with two intraabdominal and bilateral intercostal drainage catheters. She also underwent endoscopic retrograde cholangiopancreatography (ERCP) for insertion of common bile duct cover stenting over the perforation site. Again, the culture from the collection grew pandrug-resistant K. pneumoniae. She was successfully treated with a 10-day course of ceftazidime/avibactam in combination with aztreonam from Bangladesh. At least two subsequent cultures from abdominal drainage tubes after completion of ceftazidime/avibactam in combination with aztreonam did not show pandrug-resistant K. pneumoniae anymore. All the left over small intraabdominal collections were resolved at three months follow up after hospital discharge without any further antibiotic treatment.