, Volume 46, Issue 5, pp 721–724 | Cite as

A challenging case of carbapenemase-producing Klebsiella pneumoniae septic thrombophlebitis and right mural endocarditis successfully treated with ceftazidime/avibactam

  • Alessandra Iacovelli
  • Martina Spaziante
  • Samir Al Moghazi
  • Alessandra Giordano
  • Giancarlo Ceccarelli
  • Mario VendittiEmail author
Case Report



The emergence of carbapenemase-producing Klebsiella pneumonia (KPC-Kp) has become a significant problem in terms of public health and clinical outcome in many hospitals in Southern Europe. Treatment options are usually limited and effective treatment of infections caused by these pathogens is a considerable challenge for clinicians. Ceftazidime–avibactam has been recently approved for the treatment of difficult-to-treat infections due to aerobic Gram-negative organisms in patients with limited treatment options.

Case report

We reported the first case of KPC-Kp septic thrombophlebitis and right atrial endocarditis associated with metastatic lung abscesses successfully treated with a prolonged ceftazidime/avibactam plus ertapenem treatment course, suggesting that this combination therapy could be safe and effective for serious Gram-negative infections. Interestingly, we also observed an apparent discrepancy between clinical and microbiological courses: the patient became rapidly afebrile; hemodynamically stable and his procalcitonin levels showed a prompt decreasing trend. Nevertheless, blood cultures remained persistently positive for a prolonged period.


In conclusion, ceftazidime–avibactam plus ertapenem was a safe and effective therapy of serious endovascular infection due to KPC-Kp. Moreover, in this setting, follow-up blood cultures might represent an irreplaceable tool to guide the therapy.


Klebsiella pneumoniae Thrombophlebitis Endocarditis Ceftazidime–avibactam Procalcitonin 


Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018
corrected publication July 2018

Authors and Affiliations

  • Alessandra Iacovelli
    • 1
  • Martina Spaziante
    • 2
  • Samir Al Moghazi
    • 1
  • Alessandra Giordano
    • 1
  • Giancarlo Ceccarelli
    • 1
  • Mario Venditti
    • 1
    Email author
  1. 1.Department of Public Health and Infectious Diseases“Sapienza” University of RomeRomeItaly
  2. 2.Department of Clinical Medicine“Sapienza” University of RomeRomeItaly

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