Tigecycline for the Treatment of Multidrug-Resistant Klebsiella pneumoniae Meningitis

Objective: To describe the clinical utility and cerebral spinal fluid (CSF) penetration of tigecycline in a patient with multidrug-resistant Klebsiella pneumoniae meningitis. Case Summary: A 42-year-old man with a history of sickle cell disease originally presented with fever and abdominal pain due to sickling crisis; however, as a result of his altered mental status, a computed tomographic scan was obtained, and an intracranial hemorrhage was diagnosed. Postoperatively, the patients' elevated intracranial pressure was managed with an external ventricular drain. On hospital day 14, the CSF analysis was consistent with the diagnosis of meningitis. Although the Gram stain was originally negative, the culture grew K. pneumoniae susceptible to only tetracycline. Due to the severity of illness and multidrug resistant profile of the organism, the patient was initiated on tigecycline at twice the daily dose (100 mg every 12 hours). Tigecycline concentrations were determined in blood and CSF. Although these concentrations were less than the minimum inhibitory concentration determined for tigecycline, the patient responded clinically and the cultures became sterile. Discussion: As a result of the historically poor antibiotic penetration and the increasing potential for multidrug-resistant organisms in the nosocomial setting, Gram-negative infections of the central nervous system often result in high morbidity and mortality. We report the successful treatment of meningitis due to a multidrug resistant K. pneumoniae after the utilization of tigecycline administered at twice the daily dose. Conclusion: In this patient with a multidrug-resistant K. pneumoniae, high-dose tigecycline was successful despite drug concentrations in the CSF that did not exceed the minimum inhibitory concentration of the infecting pathogen.