Case Report: Severe Hypokalemia Induced by Ceftazidime-Avibactam

Abstract

Rationale Ceftazidime-avibactam is widely used to treat infections caused by carbapenem-resistant Gram-negative bacteria. It is generally safe, but severe hypokalemia related to its use has rarely been reported. Patient concerns A 74-year-old man with severe pneumonia and acute cerebral infarction was treated with ceftazidime-avibactam after sputum culture and nucleic acid testing revealed multidrug-resistant Acinetobacter baumannii and Klebsiella pneumoniae. Shortly after starting therapy, he developed persistent and refractory hypokalemia. Diagnosis The diagnosis was severe hypokalemia induced by ceftazidime-avibactam. Interventions Antimicrobial therapy was continued, and the patient received oral spironolactone and nasogastric potassium chloride. Because hypokalemia persisted and acute kidney injury developed, the ceftazidime-avibactam dose was reduced by half. After the adjustment and continued potassium replacement, serum potassium levels gradually stabilized. Outcome The patient's condition worsened due to multiple organ failure and septic shock. At the family's request, he was discharged against medical advice. Lessons This case indicates that avibactam might increase potassium loss by enhancing tubular secretion and raising the negative charge in renal tubules. Clinicians should be aware of this potential adverse effect, especially in elderly patients or those with renal dysfunction. Regular monitoring of serum and urinary potassium and early correction of abnormalities are strongly recommended during ceftazidime-avibactam treatment.