Successful treatment of a disseminated infection with extensively drug‐resistant Klebsiella pneumoniae in a liver transplant recipient with a fosfomycin‐based multidrug regimen

Abstract

Donor-derived infections with multidrug-resistant gram-negative bacteria are associated with poor outcomes, in part due to limited treatment options. Here we describe a case of donor-derived, disseminated infection with colistin-resistant, carbapenemase-producing Klebsiella pneumoniae in a liver transplant recipient that was cured with addition of intravenous fosfomycin to a multidrug regimen, in conjunction with aggressive surgical source control. Intravenous fosfomycin represents a promising adjunctive agent for use in treatment of extensively drug-resistant infections in immunocompromised hosts.

“Double carbapenem” and oral fosfomycin for the treatment of complicated urinary tract infections caused by blaNDM‐harboring Enterobacteriaceae in kidney transplantation

“…IV administration of fosfomycin is preferred in critically ill patients in whom hemodynamics might preclude the use of oral agents. Our group and others have used IV fosfomycin as part of combination therapy for severe infections caused by carbapenem‐resistant K. pneumoniae in liver transplant recipients, but this is logistically challenging because it requires importing the drug from Europe after an emergency investigational new drug application is approved by the U.S. Food and Drug Administration. Thus, considering the absence of bacteremia and the clinical stability of both patients presented here, IV fosfomycin was not considered for these cases; instead, we opted to use oral fosfomycin at doses of 3 g PO every 48‐72 hours for 21 days to treat their UTI.…”

Successful Treatment of Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Recurrent Urinary Tract Infection with High Doses of Amoxicillin with Clavulanic Acid in a Kidney Transplant Recipients: A Case Report

“…The bacterial capacity to degrade almost all β-lactam antibiotics, except carbapenems, causes resistance to standard treatment and makes long-term intravenous antibiotic therapy necessary. The growing problem of bacterial resistance and lack of efficacy of standard antibiotic treatment led to the implementation of a nonstandard therapies (3,4). Several reports confirm observations that high doses of beta-lactam antibiotics could overcome bacterial resistance in vivo.…”

Carbapenem-Resistant Enterobacteriaceae in Solid Organ Transplantation: Management Principles

“…The Spanish Society of Transplant (SET), the Group for Study of Infection in Transplantation of the Spanish Society of I nf ec t i ou s D i s e as e s a n d C l i ni ca l Mi cr ob i o l o g y (GESITRA_EIMC), and the Spanish Network for Research in Infectious Diseases (REIPI) recent guidelines for management of CRE in SOT recommend that recipients should receive a minimum of 7 days of effective antibiotics posttransplant and that consideration should be given to avoiding kidney donation from a patient with a CRE-related UTI or lung donation from a patient with CRE-related lower respiratory tract infection or any patient with a CRE bacteremia entirely [5]. Given reports of CRE infections occurring in recipients of organs from donors who were thought to only have localized infections of other organs, prophylactic targeted therapy to the recipient and donor, where feasible, is likely prudent [38].…”