Successful CAZ-avibactam treatment of MDR-KPC-positive Kleb pneumoniae infection in a patient with traumatic brain injury.

August 5, 2017 at 9:21 am

MEDICINE August 2017 V.96 N.31 P e7664

Rationale

Carbapenem-resistant Enterobacteriaceae infections are a serious health care problem, because of the high mortality. Carbapenem resistance is mainly caused by carbapenemases production, including Klebsiella pneumoniae carbapenemase (KPC).

Ceftazidime-avibactam is a new cephalosporin/β-lactamase inhibitor combination for the treatment of complicated urinary, intra-abdominal infections, and nosocomial pneumonia caused by gram negative, or other serious gram-negative infections.

Patient concerns

We showed the case of a 27-year-old patient, hospitalized for traumatic brain injury and chest trauma, with KPC-producing Klebsiella pneumoniae infection.

Diagnoses

Blood and bronchial aspirate culture analysis detected an infection caused by MDR Klebsiella pneumoniae, resistant to meropenem, ertapenem, piperacillin/tazobactam, amoxicillin/clavulanic acid, aztreonam, ceftazidime, cefotaxime, cefepime, amikacin, ciprofloxacin, trimethoprim/sulfamethoxazole, colistin while it showed an intermediate sensitivity to gentamicin and was sensitive to ceftazidime-avibactam. Molecular analyses revealed that the isolate belonged to the epidemic clone sequence type 258 (ST258) carrying blaKPC-3, blaTEM-1, and blaSHV-11genes.

Interventions

After various combined antibiotic therapies without improvements, he was treated with ceftazidime-avibactam, on a compassionate-use basis.

Outcomes

With ceftazidime-avibactam monotherapy clinical and microbiological clearance was obtained. A week after the end of the therapy microbiological analysis was repeated and a positive rectal swab for KPC-Klebsiella pneumoniae was found, becoming negative after 1 month. Moreover, the patient did not show any relapses for up to 18 weeks.

Lessons

This case indicates that ceftazidime-avibactam monotherapy could be efficacious against KPC positive Klebsiella pneumoniae infections.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/08040/Successful_ceftazidime_avibactam_treatment_of.24.aspx

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Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Epidemiología, Health Care-Associated Infections, Infecciones del SNC, Infecciones nosocomiales, Metodos diagnosticos, REPORTS, Resistencia bacteriana, Sepsis, Update.

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