Off-Label Use of Ceftazidime/Avibactam for the Treatment of Pan-Drug-Resistant <i>Klebsiella pneumoniae</i> in a Neonate: Case Report and Literature Review

• Main Authors: Iliya Mangarov (Author), Ralitsa Georgieva (Author), Valentina Petkova (Author), Irina Nikolova (Author)
• Format: Book
• Published: MDPI AG, 2023-08-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.3390/antibiotics12081302; 2079-6382
• Keywords: ceftazidime/avibactam; neonate; pan-drug-resistant; <i>Klebsiella pneumoniae</i>; Therapeutics. Pharmacology; RM1-950
• Source: Antibiotics, Vol 12, Iss 8, p 1302 (2023)

Background: <i>Klebsiella pneumoniae</i> is among the most common Gram-negative bacteria isolated to neonatal intensive care units (NICU) and one of the leading causes of morbidity and mortality. The ceftazidime/avibactam (CAZ-AVI) combination is approved for infections caused by aerobic Gram-negative organisms. It is licensed for use in infants over 3 months old. There are no safety and efficacy data regarding the administration of CAZ-AVI to infants younger than 3 months, except for a few case reports. Case presentation: This report describes a severely intoxicated 24-day-old, full-term, male neonate transferred to NICU level III from a secondary maternity hospital due to the deterioration of his general condition. On day four of admission, blood culture revealed the pan-drug-resistant (PDR) <i>K. pneumoniae</i> ss. pneumoniae, susceptible only to CAZ-AVI, which thus represented the only treatment option. Off-label CAZ-AVI was administered intravenously as a salvage therapy. Conclusions: In healthcare settings, treating resistant <i>K. pneumoniae</i> presents serious challenges, especially in NICU patients. The off-label treatment with CAZ-AVI for 17 days was safe and effective in this one-month-old patient. A year later, the patient was healthy with normal cognitive development.