BACKGROUND: Gram-negative bacterial resistance to antibiotics is of increasing concern. Carbapenem resistance among strains of Klebsiella pneumoniae is a relatively new phenomenon. Resistance attributable to production of carbapenemases is notoriously difficult to combat. METHODS: Case report and review of the pertinent English-language literature. RESULTS: A patient, hospitalized for aortic dissection complicated by intra-abdominal catastrophe and acute kidney injury, developed bacteremia exhibiting meropenem non-susceptibility secondary to expression of bla(KPC-2). High-dose, continuous-infusion meropenem achieved serum drug concentrations above the minimum inhibitory concentration and eradicated the infection. CONCLUSION: This is the first report of a meropenem-non-susceptible carbapenamase-positive Klebsiella pneumoniae blood stream infection treated successfully with high-dose, continuous-infusion meropenem. Application of this regimen in certain patients, such as those with mild-to-moderate renal insufficiency, may be a reasonable option for multi-drug-resistant nosocomial infections.
BACKGROUND: Gram-negative bacterial resistance to antibiotics is of increasing concern. Carbapenem resistance among strains of Klebsiella pneumoniae is a relatively new phenomenon. Resistance attributable to production of carbapenemases is notoriously difficult to combat. METHODS: Case report and review of the pertinent English-language literature. RESULTS: A patient, hospitalized for aortic dissection complicated by intra-abdominal catastrophe and acute kidney injury, developed bacteremia exhibiting meropenem non-susceptibility secondary to expression of bla(KPC-2). High-dose, continuous-infusion meropenem achieved serum drug concentrations above the minimum inhibitory concentration and eradicated the infection. CONCLUSION: This is the first report of a meropenem-non-susceptible carbapenamase-positive Klebsiella pneumoniae blood stream infection treated successfully with high-dose, continuous-infusion meropenem. Application of this regimen in certain patients, such as those with mild-to-moderate renal insufficiency, may be a reasonable option for multi-drug-resistant nosocomial infections.
Authors: Ryan K Shields; M Hong Nguyen; Brian A Potoski; Ellen G Press; Liang Chen; Barry N Kreiswirth; Lloyd G Clarke; Gregory A Eschenauer; Cornelius J Clancy Journal: Antimicrob Agents Chemother Date: 2014-12-22 Impact factor: 5.191
Authors: Asma Khatri; Nina Naeger Murphy; Peter Wiest; Melissa Osborn; Kathleen Garber; Michelle Hecker; Kelly Hurless; Susan D Rudin; Michael R Jacobs; Robert C Kalayjian; Robert A Salata; David van Duin; Federico Perez; Robert A Bonomo; David L Paterson; Patrick N A Harris Journal: Antimicrob Agents Chemother Date: 2015-08 Impact factor: 5.191