Hospital-Acquired Pneumonia due to ESBL-Producing Klebsiella pneumoniae in a Patient with a Large Frontal Meningioma: A Case Report

Abstract

Background: Hospital-acquired pneumonia (HAP) is a lower respiratory tract infection occurring ≥48 hours after hospital admission and not incubating at the time of entry. Extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae is a major etiological agent linked to increased morbidity, mortality, and length of stay in HAP cases. Patients with meningioma, especially those undergoing long-term hospitalization, have a higher risk of experiencing complications such as HAP. This case highlights the interaction between the underlying neurological condition and a nosocomial infection.

Case: A 44-year-old female patient presented with complaints of headache accompanied by vomiting. An MRI was performed, revealing a meningioma on the left posterior frontal convexity, measuring 6 x 6 x 6 cm. On hospital day 5, the patient experienced a decrease in consciousness accompanied by shortness of breath. She was cared for in the ICU, was intubated, and was given empirical meropenem while awaiting sputum culture results. The culture revealed ESBL-positive Klebsiella pneumoniae. After 3 days of antibiotics, the patient's consciousness improved, and laboratory and chest X-ray evaluations showed improvement.

Discussion: Timely and targeted therapy, such as the administration of appropriate empirical antibiotics consistent with current guidelines by the ATS/IDSA, can improve prognosis and prevent a worsening of the infection and improve prognosis. Preventive measures are needed at reducing the risk of recurrent aspiration and pulmonary infections.

Conclusion: Patients with meningioma have a high risk of developing nosocomial pneumonia during a prolonged hospital stay. The therapy of suitable empirical antibiotics for initial management provides a good prognosis to prevent the infection from worsening.