{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:10:13Z","timestamp":1785798613411,"version":"3.56.0"},"reference-count":9,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,5,12]]},"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:p>A man in his 40s with type 2 diabetes mellitus had persistent right-sided watery nasal discharge for 6\u2009months following cerebrospinal fluid (CSF) leak repair at another hospital, prompting his visit to us due to recurring symptoms. Imaging revealed a CSF leak from the mid-clivus for which revision endoscopic CSF leak repair was done. Regrettably, he developed postoperative meningitis caused by multidrug-resistant (MDR) <jats:italic>Klebsiella pneumoniae<\/jats:italic>.<\/jats:p>\n               <jats:p>Managing this complex case was a challenging task due to the pathogen\u2019s resistance to conventional drugs and the scarcity of scientific evidence. We initiated a culture-guided combination regimen with ceftazidime, avibactam, aztreonam and tigecycline. This decision stemmed from meticulous literature review and observed antibiotic synergy while testing for this organism.<\/jats:p>\n               <jats:p>After 4\u2009weeks of vigilant treatment, the patient\u2019s symptoms improved significantly, and CSF cultures were sterile. We present our approach to effectively confront and manage a challenging instance of postoperative MDR bacterial meningitis.<\/jats:p>","DOI":"10.1136\/bcr-2023-257872","type":"journal-article","created":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T03:10:11Z","timestamp":1718593811000},"page":"e257872","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Confronting multidrug-resistant <i>Klebsiella<\/i> meningitis after mid-clival Cerebrospinal Fluid leak repair: a therapeutic odyssey"],"prefix":"10.1136","volume":"17","author":[{"given":"Anbarasi","family":"Madoure","sequence":"first","affiliation":[{"name":"Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8927-8388","authenticated-orcid":false,"given":"Dharanya","family":"Gopalakrishnan Srinivasan","sequence":"additional","affiliation":[{"name":"Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4936-5316","authenticated-orcid":false,"given":"Tejaswi","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1007-7776","authenticated-orcid":false,"given":"Lokesh Kumar","family":"Penubarthi","sequence":"additional","affiliation":[{"name":"Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,6,16]]},"reference":[{"key":"2025082701005758000_17.6.e257872.1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkx358"},{"key":"2025082701005758000_17.6.e257872.2","doi-asserted-by":"crossref","unstructured":"Sahu M , Sanjith S , Bhalekar P , et al . Waging war against extended spectrum beta Lactamase and Metallobetalactamase producing Pathogens- novel adjuvant antimicrobial agent Cse1034- an extended hope. 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