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Successful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam
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Successful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam
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Successful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam
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Journal Article
Successful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam
2021
Overview
Pandrug-resistant (PDR)
K. pneumoniae
refractory to conventional treatment has been reported worldwide, causing a huge burden on the healthcare system, patient safety and the economy.
K. pneumoniae
is a prominent opportunistic pathogen causing hospital-acquired and community-acquired infections, but is rarely associated with infective endocarditis. Currently, there are sparse data guiding the optimal regimen when commonly used antibiotics fail, notably for the treatment of endocarditis infections. Here we report our experience in treating a 40-year-old female with PDR
K. pneumoniae
infection of cardiovascular implantable electronic device (CIED) and right-sided infective endocarditis. Initial susceptibility testing of the incriminated pathogen showed an apparent susceptibility to colistin but the prolonged course of colistin, gentamicin and meropenem did not resolve the infection. However, the synergistic combinations of aztreonam with ceftazidime-avibactam was able to overcome resistance and clear the infection rapidly. Genome sequencing showed that the PDR
K. pneumoniae
isolate belongs to the international high-risk clone ST14. The isolate harbored genes encoding NDM-1, OXA-48, CTX-M-14b, SHV-28 and OXA-1, explaining resistance to all β-lactams, including carbapenems. It carried the
armA
gene conferring resistance to all clinically important aminoglycosides and had alterations in GyrA, ParC and MgrB, explaining resistance to ciprofloxacin and colistin.
Publisher
Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
Subject
/ Adult
/ Azabicyclo Compounds - administration & dosage
/ Azabicyclo Compounds - pharmacology
/ Azabicyclo Compounds - therapeutic use
/ Aztreonam - administration & dosage
/ Ceftazidime - administration & dosage
/ Ceftazidime - therapeutic use
/ Colistin
/ Drug Resistance, Multiple, Bacterial - drug effects
/ Female
/ Genomes
/ Humanities and Social Sciences
/ Humans
/ Klebsiella pneumoniae - drug effects
/ Klebsiella pneumoniae - pathogenicity
/ Science
