ABSTRACT
OBJECTIVES: Carbapenem resistance in Klebsiella pneumoniae is an increasing problem worldwide and infections caused by this bacterium can be difficult to treat. This study reported the case of a patient from Romania, who was hospitalised in Bulgaria after an accident trauma. He then came to France for treatment of an osteitis caused by a Klebsiella pneumoniae carrying both blaNDM-1 and blaOXA-48. METHOD: The resistome of this extremely drug-resistant bacterium was analysed both with phenotypic (large antibiotic susceptibility testing) and genomic methods (genome sequencing). The genetic environment of the two carbapenemases was studied. RESULTS: Klebsiella pneumoniae ST307 carrying both a blaNDM-1 and blaOXA-48 gene was located on two different plasmids: Inc L/M and IncFII. The patient was successfully treated by a combination of intravenous colistin (9 MUI, then 4.5 MUI bd), intravenous fosfomycin (4g tds) and oral doxycycline (100mg bd) for 3 months. Faecal microbiota transplantation was successfully conducted for stool carriage. CONCLUSION: The ST307 type is becoming endemic in hospital environments and is frequently associated with carbapenem resistance. Treatment of infection caused by multidrug-resistant bacteria is a clinical challenge, and the use of old antibiotics associated with screening and decolonisation of the reservoirs can be an efficient therapeutic alternative.
Subject(s)
Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/metabolism , Osteitis/microbiology , Osteitis/therapy , beta-Lactamases/genetics , beta-Lactamases/metabolism , Adult , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacterial Proteins/adverse effects , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Carbapenems/therapeutic use , Drug Resistance, Multiple, Bacterial/drug effects , Drug Resistance, Multiple, Bacterial/genetics , Fecal Microbiota Transplantation/methods , Humans , Klebsiella pneumoniae/enzymology , Klebsiella pneumoniae/pathogenicity , Male , Microbial Sensitivity Tests , Osteitis/chemically induced , Plasmids/genetics , Whole Genome Sequencing , beta-Lactamases/adverse effectsSubject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Proteins/adverse effects , Ciprofloxacin/therapeutic use , Enterobacter cloacae/isolation & purification , Enterobacteriaceae Infections/drug therapy , Fosfomycin/therapeutic use , Postoperative Complications/drug therapy , Soft Tissue Infections/drug therapy , beta-Lactamases/adverse effects , Aged , Amikacin/therapeutic use , Anti-Bacterial Agents/administration & dosage , Ciprofloxacin/administration & dosage , Colonic Diseases/complications , Drug Synergism , Drug Therapy, Combination , Enterobacter cloacae/drug effects , Enterobacteriaceae Infections/etiology , Female , Fosfomycin/administration & dosage , Hernia, Abdominal/surgery , Herniorrhaphy , Humans , Intestinal Fistula/complications , Minocycline/analogs & derivatives , Minocycline/therapeutic use , Postoperative Complications/etiology , Postoperative Complications/microbiology , Prosthesis-Related Infections/drug therapy , Prosthesis-Related Infections/microbiology , Soft Tissue Infections/microbiology , Surgical Mesh/adverse effects , TigecyclineABSTRACT
Se aislaron cepas de Staphylococcus aureus resistentes a penicilina y productoras de ß-lactamasas. Mediante el método de dilución en tubos, se calculó la concentración inhibitoria CIM para amoxicilina-sulbactam, con diferente tensión de oxígeno y frente a heparina. Los valores de CIM se redujeron significativamente al sumar sulbactam al antibiótico. La disminución del oxígeno no afectó la capacidad inhibidora de ß-lactamasas del sulbactam, del mismo modo que la presencia de heparina no interfirió en su efecto protector sobre la amoxicilina. Estos resultados reafirmaron el concepto de efectividad de la combinación amoxicilina-sulbactam sobre los procesos infecciosos a S. aureus productores de ß-lactamasas, aun en afecciones donde se genera anaerobiosis relativa y también en enfermos con tratamiento simultáneo con heparina
Subject(s)
Amoxicillin/antagonists & inhibitors , Anaerobiosis/drug effects , beta-Lactamases/antagonists & inhibitors , Drug Resistance, Microbial/physiology , Staphylococcal Infections/drug therapy , Sulbactam/therapeutic use , Amoxicillin/therapeutic use , beta-Lactamases/adverse effects , Adjuvants, Pharmaceutic/therapeutic use , Heparin/adverse effects , Staphylococcal Infections/enzymology , Staphylococcal Infections/physiopathology , Staphylococcus aureus/drug effects , Staphylococcus aureus/enzymology , Sulbactam/antagonists & inhibitors , Sulbactam/pharmacokineticsABSTRACT
Se aislaron cepas de Staphylococcus aureus resistentes a penicilina y productoras de ß-lactamasas. Mediante el método de dilución en tubos, se calculó la concentración inhibitoria CIM para amoxicilina-sulbactam, con diferente tensión de oxígeno y frente a heparina. Los valores de CIM se redujeron significativamente al sumar sulbactam al antibiótico. La disminución del oxígeno no afectó la capacidad inhibidora de ß-lactamasas del sulbactam, del mismo modo que la presencia de heparina no interfirió en su efecto protector sobre la amoxicilina. Estos resultados reafirmaron el concepto de efectividad de la combinación amoxicilina-sulbactam sobre los procesos infecciosos a S. aureus productores de ß-lactamasas, aun en afecciones donde se genera anaerobiosis relativa y también en enfermos con tratamiento simultáneo con heparina (AU)