Coinfections of Two Strains of NDM-1- and OXA-232-Coproducing Klebsiella pneumoniae in a Kidney Transplant Patient

Antimicrob Agents Chemother. 2020 Mar 24;64(4):e00948-19. doi: 10.1128/AAC.00948-19. Print 2020 Mar 24.

Abstract

We report here a fatal case of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in a renal transplant patient without a travel history in the prior year, from whom 2 genetically different CRKP (sequence type 14 [ST14] and ST2497) strains carrying the same plasmids and antimicrobial resistance genes, including blaNDM-1, blaOXA-232, blaCTX-M-15, armA, and tet(D), were isolated from blood and the abdominal cavity. The isolates were susceptible to colistin, tigecycline, eravacycline, and cefiderocol, which was used to treat the CRKP in combination with ceftazidime-avibactam and polymyxin B and resulted in bacterial clearance. Despite the aggressive treatment, the patient died of ischemic colitis and multiorgan failure.

Keywords: CRKP; NDM-1; OXA-232; ST14; ST2497; carbapenem resistance; carbapenemase coproduction; cefiderocol.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Coinfection
  • Female
  • Humans
  • Kidney Transplantation / adverse effects
  • Klebsiella Infections / drug therapy*
  • Klebsiella Infections / mortality
  • Klebsiella pneumoniae / drug effects*
  • Klebsiella pneumoniae / genetics
  • Klebsiella pneumoniae / isolation & purification
  • Methyltransferases / genetics
  • Microbial Sensitivity Tests
  • Plasmids / genetics
  • beta-Lactamases / genetics*

Substances

  • Anti-Bacterial Agents
  • Methyltransferases
  • beta-lactamase CTX-M-15
  • beta-Lactamases
  • beta-lactamase NDM-1
  • beta-lactamase OXA-232, Klebsiella pneumoniae