Community-acquired Klebsiella oxytoca endocarditis: A case report

Chen, Ju‐Yi; Chen, Po-Sheng; Chen, Yaping; Lee, Wei‐Ting; Lin, Long-Yau

doi:10.1016/j.jinf.2005.08.015

Cited by 12 publications

(11 citation statements)

References 10 publications

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“…IE in transplant recipients may be successfully managed with antibiotic therapy alone but rare and multi-resistant bacterial organisms must be considered [2][3][4][5][6][7][8][9][10][11][12]. The reported high mortality rate of ESBL positive sepsis seems to be due to the wrong choice of initial antibiotic treatment; commonly including betalactam/betalactamase inhibitor combinations as also emphasized by Zimhony [1,[15][16][17][18]. Immediately post LT our patient did not show evidence of infection.…”

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confidence: 99%

Fatal endocarditis due to extended spectrum betalactamase producing Klebsiella terrigena in a liver transplant recipient

Goegele¹,

Ruttmann²,

Aranda-Michel³

et al. 2007

Wien Klin Wochenschr

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Fatal endocarditis due to extended spectrum betalactamase producing Klebsiella terrigena in a liver transplant recipientSir,We would like to report a case of infective endocarditis (IE) due to extended spectrum betalactamase (ESBL) producing Klebsiella terrigena. Klebsiella terrigena is a rarely encountered Gram negative rod and many microbiological laboratories still do not subtype Klebsiella to the species level. This is only the third reported case of IE due to ESBL producing Klebsiella, the second case in an adult and the first case in an organ recipient. Zimhony et al. reported on successful conservative therapy in an immuncompetent patient. However, in the immunocompromised host, a different management including surgery maybe is required [1]. Transplant recipient are at high risk for IE but still many cases are discovered at an advanced stage or post mortem [2][3][4][5][6][7][8][9][10][11][12]. In a series of 666 liver transplants performed during a 15 year period at our institution, we identified five patients with post mortem diagnosed IE. Fever, lassitude, and signs of inflammation can be absent in transplant recipients with infections and also can be present during acute rejection or other conditions of graft dysfunction.Our patient was a 45 year-old comatose, severe malnourished man with acute renal failure who underwent liver transplantation (LT) for chronic hepatitis C. The intraoperative course was unremarkable and transesophageal echocardiography for hemodynamic monitoring found all valves normal. Initial graft function was excellent. Perioperative prophylaxis included piperacillin/tazobactam, ciprofloxacin, vancomycin and liposomal amphotericin B. Sputum, throat swab and urine prior to LT grew ESBL producing Klebsiella and piperacillin/tazobactam was continued for 10 days, as the pathogen was reported to be sensitive. Immunosuppressive therapy included IL-2 receptor antagonist, mycophenolate-mofetil and steroids; tacrolimus was initiated on day 9 post LT (trough levels of 4-8 ng/ml). On day 24 he developed fever, and ertapenem (1 g daily) was added as Klebsiella was cultured from bronchial secretions. Subsequently the patient defervescenced. On day 48 post LT pneumonia was diagnosed on CT-scan. Empirical treatment included azithromycin, teicoplanin and meropenem with initial response. He clinically deteriorated and required ventilation. Multi-resistant coagulase negative staphylococci (MRCNS) were isolated from sputum and vancomycin was started, which was later changed to linezolid. Immunosuppression was tapered but the infection did not improve and graft dysfunction with cholestasis developed. Liver biopsy showed findings compatible with sepsis, however, mild rejection could not be ruled out. Graft function further worsened and bolused steroids were given without success. Immunosuppression was changed to low dose sirolimus (trough levels of < 5 ng/ml) monotherapy. On day 90 blood cultures became positive for MRCNS and vancomycin was again administered. Klebsiella spp. was isolated from sputum and...

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confidence: 99%

Fatal endocarditis due to extended spectrum betalactamase producing Klebsiella terrigena in a liver transplant recipient

Goegele¹,

Ruttmann²,

Aranda-Michel³

et al. 2007

Wien Klin Wochenschr

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“…Endocarditis and liver abscess caused by this organism have been reported recently. 1,2 Although K. pneumoniae is one of the most common causes of monomicrobial necrotizing fasciitis, 3 we report the fi rst case, to our knowledge, of K. oxytoca causing necrotizing fasciitis.…”

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confidence: 78%

A fatal case of necrotizing fasciitis due to bacterial translocation of Klebsiella oxytoca

Oishi

Kagawa

Mitsumizo

et al. 2008

Journal of Infection and Chemotherapy

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“…Klebsiella oxytoca bacteremia is commonly seen in the setting of hepatobiliary tract, urinary tract, skin and soft tissue, and peritoneal infection. 5 Lin et al 6 reported biliary tract infection in more than 50% of patients with Klebsiella oxytoca bacteremia; however, none of these cases were screened for IE. Although the gall bladder drainage did not grow Klebsiella oxytoca , we believe that the port of entry in our patient was the gall bladder infection.…”

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confidence: 99%

Klebsiella oxytoca Endocarditis With Complete Heart Block

Ullah

Elbita

Abdelghany

et al. 2016

Journal of Investigative Medicine High Impact Case Reports

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Gram-negative bacterial endocarditis causes 5% of all bacterial endocarditis. Among gram-negative bacteria, Klebsiella species are rare causes of native valve endocarditis. Klebsiella oxytoca is an extremely rare subspecies that can infrequently cause endocarditis and is associated with poor outcome. We report a case of Klebsiella oxytoca endocarditis in an elderly man who initially presented with stroke but later developed sepsis and heart block secondary to endocarditis.

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Community-acquired Klebsiella oxytoca endocarditis: A case report

Cited by 12 publications

References 10 publications

Fatal endocarditis due to extended spectrum betalactamase producing Klebsiella terrigena in a liver transplant recipient

Fatal endocarditis due to extended spectrum betalactamase producing Klebsiella terrigena in a liver transplant recipient

A fatal case of necrotizing fasciitis due to bacterial translocation of Klebsiella oxytoca

Klebsiella oxytoca Endocarditis With Complete Heart Block

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