Cefotaxime plus polymyxin B achieves complete recovery in pan-resistant Klebsiella pneumoniae chest wall infection

Treating deep-seated infections caused by Carbapenem-resistant Klebsiella pneumoniae (CRKP), especially pan-resistant strains, presents a significant therapeutic challenge due to limited effective options and high mortality rates. These infections often require aggressive interventions like repeated debridements and can lead to severe complications such as acute kidney injury and ICU admission. While polymyxins are frequently used, their efficacy against highly resistant strains can be suboptimal, necessitating novel or synergistic treatment strategies to overcome drug resistance and improve patient outcomes.

This case report details a 43-year-old man suffering from recurrent deep anterior chest wall and thoracoabdominal soft-tissue infection caused by pan-resistant Klebsiella pneumoniae. Initially, the patient received polymyxin B and tigecycline, which led to temporary improvement before a severe recurrence. Following this, treatment was switched to a combination of cefotaxime plus polymyxin B. The clinical outcome was monitored, and the efficacy of this new regimen was subsequently confirmed by in vitro synergy testing.

The patient experienced prolonged hospitalization from January to April 2025, undergoing repeated debridements and skin grafting, complicated by flap infection, acute kidney injury, and ICU admission. Despite initial improvement with polymyxin B and tigecycline, a severe recurrent infection with pan-resistant K. pneumoniae emerged in June 2025. Given the critically limited therapeutic options, a switch to cefotaxime plus polymyxin B was initiated. This change in regimen led to a favorable clinical outcome. > The patient achieved complete clinical recovery following treatment with cefotaxime plus polymyxin B, a result later corroborated by in vitro synergy data, demonstrating the effectiveness of this specific combination against the pan-resistant strain.