Complex prosthetic joint infections due to carbapenemase-producing Klebsiella pneumoniae: a unique challenge in the era of untreatable infections

Abstract

SUMMARY Objectives Limited clinical experience exists regarding the management of prosthetic joint infection (PJI) due to multidrug-resistant (MDR) Gram-negative organisms. We review three cases of carbapenem-resistant Klebsiella pneumoniae (CRKP) complicating PJI. Methods This was a retrospective study of all patients at a tertiary care institution with CRKP complicating PJI between January 2007 and December 2010. Demographic data, procedures, organisms involved, length of stay, antibiotic treatments, and outcomes were collected. Antimicrobial susceptibility testing was performed on CRKP isolates, and the mechanism of resistance was ascertained by PCR. Results This analysis demonstrated that: (1) the CRKP possessed blaKPC and were difficult to eradicate (persistent) in PJI; (2) multiple surgeries and antibiotic courses were undertaken and patients required a prolonged length of stay; (3) resistance to colistin and amikacin emerged on therapy; (4) the same strain of CRKP may be responsible for relapse of infection; (5) significant morbidity and mortality resulted. Conclusions These cases highlight the opportunistic and chronic nature of CRKP in PJIs and the need for aggressive medical and surgical treatment. Further investigations of the management of CRKP PJI and new drug therapies for infections due to MDR Gram-negative organisms are urgently needed.

Patient Factors Associated with Failure of Flap Coverage Used during Revision Total Knee Arthroplasty

“…When the systemic infection was cleared after the second revision, antibiotics were stopped, and the patient's knee appeared noninfected at 8 months of follow-up. 19 CHF has been reported as an independent risk factor for surgical site infection in patients undergoing total knee and hip arthroplasty, 20 which is further supported by the results of this study. Given the variability in these patients' volume status, it is plausible that increased hydrostatic pressure on the region of soft tissue coverage can lead to wound dehiscence, persistence of infection, and eventual limb amputation.…”

45S5Bioglass®-based scaffolds coated with selenium nanoparticles or with poly(lactide-co-glycolide)/selenium particles: Processing, evaluation and antibacterial activity

“…M a n u s c r i p t Klebsiella pneumoniae also may colonize sites when the host defenses are compromised and cause a variety of lung, bone, heart and bloodstream infections [44]. All of them may be highly resistant to traditional antibiotic therapies [25,45].…”

Efficacy of colistin alone and in various combinations for the treatment of experimental osteomyelitis due to carbapenemase-producing Klebsiella pneumoniae

“…2 Posttraumatic or post-operative osteomyelitis and prosthetic joint infection (PJI) due to CPE have been more recently described in countries where CPE is endemic or in hospitals receiving patients from endemic areas. 3,4 Treatment of these infections is especially difficult because they present a combination of the main current challenges in the field of antibiotics. First, despite the recent approval of new compounds, such as ceftazidime/ avibactam, therapeutic options remain scarce and could rely on old antibacterial agents with limited clinical data on their efficacy and a high risk of adverse events.…”