Two cases of monomicrobial intraabdominal abscesses due to KPC - 3 Klebsiella pneumoniaeST258 clone

Abstract

BackgroundKnowledge of the etiology of pyogenic liver and pancreatic abscesses is an important factor in determining the success of combined surgical and antibiotic treatment. Literature shows geographical variations in the prevalence and distribution of causative organisms, and the spread of Klebsiella pneumoniae carbapenemase-producing bacteria is an emerging cause of abdominal infections.Case presentationWe herein describe two cases of intra-abdominal abscesses due to monomicrobial infection by Klebsiella pneumoniae Sequence Type 258 producing K. pneumoniae carbapenemase 3 (KPC-Kp). In case 1, a 50-year-old HIV-negative Italian woman with chronic pancreatitis showed infection of a pancreatic pseudocystic lesion caused by KPC-Kp. In case 2, a 64-year-old HIV- negative Italian woman with pancreatic neoplasm and liver metastases developed a liver abscess due to KPC after surgery. Both women were admitted to our hospital but to different surgical units. The clonal relationship between the two isolates was investigated by pulsed-field gel electrophoresis (PFGE). In case 2, the patient was already colonized at admission and inter-hospital transmission of the pathogen was presumed. A long-term combination regimen of colistin with tigecycline and percutaneous drainage resulted in full recovery and clearance of the multidrug-resistant (MDR) pathogen.ConclusionsTimely microbiological diagnosis, the combined use of new and old antibiotics and radiological intervention appeared to be valuable in managing these serious conditions. The emergence and dissemination of MDR organisms is posing an increasing challenge for physicians to develop new therapeutic strategies and control and prevention frameworks.

KPC - 3 Klebsiella pneumoniaeST258 clone infection in postoperative abdominal surgery patients in an intensive care setting: analysis of a case series of 30 patients

“…As in our previous report [8], this observation is consistent with those of other authors, such as Hirsch [16], who describe even higher clinical success rates when using polymyxins in combination.…”

“…Ten patients had also received carbapenem therapy in the past. This is consistent with data from surveillance studies that report patients colonized with MDRGN before hospital admission [5,8] and with previous literature data describing the prolonged carriage of multidrug resistant bacterial strains following hospital discharge [8,14,15]. …”

“…Since then, colonizations or infections with KPC-Kp have become endemic and have also been described in different healthcare settings, such as in surgical wards [8]. …”

Genomics of KPC-Producing Klebsiella pneumoniae Sequence Type 512 Clone Highlights the Role of RamR and Ribosomal S10 Protein Mutations in Conferring Tigecycline Resistance

“…Since 2008, K. pneumoniae strains producing KPC carbapenemases have been detected in many different Italian hospitals. In particular, the clones designated sequence type 258 (ST258) and ST512 are the most frequently reported K. pneumoniae clones in this country, both belonging to the clonal group CC258 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In the period from 2010 to 2011, two surveillance studies were performed in 10 hospitals in Rome, collecting Ͼ100 KPC-3-producing K. pneumoniae strains belonging to CC258; several strains showed reduced susceptibility or resistance to tigecycline (6).…”

Surgical pathology and the diagnosis of invasive visceral yeast infection: two case reports and literature review

“…Medical progress, which has resulted in a growing number of invasive procedures, new dimensions in aggressive immunosuppressive and immunomodulatory treatments and widespread use of broad-spectrum antibiotics, is the main catalyst for this development [1-3]. …”