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Successful ceftazidime-avibactam treatment of MDR-KPC-positive Klebsiella pneumoniae infection in a patient with traumatic brain injury: A case report.
Medicine (Baltimore). 2017 Aug; 96(31):e7664.M

Abstract

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.

Authors+Show Affiliations

aIRCCS Centro Neurolesi "Bonino-Pulejo", Via Provinciale Palermo, Messina bSection of Microbiology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28767588

Citation

Gugliandolo, Agnese, et al. "Successful Ceftazidime-avibactam Treatment of MDR-KPC-positive Klebsiella Pneumoniae Infection in a Patient With Traumatic Brain Injury: a Case Report." Medicine, vol. 96, no. 31, 2017, pp. e7664.
Gugliandolo A, Caio C, Mezzatesta ML, et al. Successful ceftazidime-avibactam treatment of MDR-KPC-positive Klebsiella pneumoniae infection in a patient with traumatic brain injury: A case report. Medicine (Baltimore). 2017;96(31):e7664.
Gugliandolo, A., Caio, C., Mezzatesta, M. L., Rifici, C., Bramanti, P., Stefani, S., & Mazzon, E. (2017). Successful ceftazidime-avibactam treatment of MDR-KPC-positive Klebsiella pneumoniae infection in a patient with traumatic brain injury: A case report. Medicine, 96(31), e7664. https://doi.org/10.1097/MD.0000000000007664
Gugliandolo A, et al. Successful Ceftazidime-avibactam Treatment of MDR-KPC-positive Klebsiella Pneumoniae Infection in a Patient With Traumatic Brain Injury: a Case Report. Medicine (Baltimore). 2017;96(31):e7664. PubMed PMID: 28767588.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Successful ceftazidime-avibactam treatment of MDR-KPC-positive Klebsiella pneumoniae infection in a patient with traumatic brain injury: A case report. AU - Gugliandolo,Agnese, AU - Caio,Carla, AU - Mezzatesta,Maria Lina, AU - Rifici,Carmela, AU - Bramanti,Placido, AU - Stefani,Stefania, AU - Mazzon,Emanuela, PY - 2017/8/3/entrez PY - 2017/8/3/pubmed PY - 2017/8/23/medline SP - e7664 EP - e7664 JF - Medicine JO - Medicine (Baltimore) VL - 96 IS - 31 N2 - 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. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/28767588/Successful_ceftazidime_avibactam_treatment_of_MDR_KPC_positive_Klebsiella_pneumoniae_infection_in_a_patient_with_traumatic_brain_injury:_A_case_report_ L2 - http://dx.doi.org/10.1097/MD.0000000000007664 DB - PRIME DP - Unbound Medicine ER -