Favorable clinical outcome of recurrent deep chest wall infection caused by pan-resistant Klebsiella pneumoniae treated with cefotaxime plus polymyxin B: a case report

This case report describes a 43-year-old man admitted in November 2024 with recurrent deep anterior chest wall and thoracoabdominal soft-tissue infection caused by Klebsiella pneumoniae. Multidrug-resistant K. pneumoniae was isolated in December 2024. From January to April 2025, the patient required prolonged hospitalization, repeated debridements, and skin grafting, complicated by flap infection, acute kidney injury, and ICU admission. After initial improvement with polymyxin B and tigecycline, a severe recurrent infection caused by pan-resistant K. pneumoniae occurred in June 2025. Given the limited therapeutic options, treatment was changed to cefotaxime plus polymyxin B, leading to complete clinical recovery, which was later confirmed by in vitro synergy results.

Keywords:
Antimicrobial resistance; Pan-resistant K. pneumoniae; Cefotaxime; Polymyxin B; Case report; Synergism