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Klebsiella pneumoniae: development of a mixed population of carbapenem and tigecycline resistance during antimicrobial therapy in a kidney transplant patient.
- Source :
-
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2012 Jan; Vol. 18 (1), pp. 61-6. Date of Electronic Publication: 2011 Jul 01. - Publication Year :
- 2012
-
Abstract
- Nine isolates of Klebsiella pneumoniae were isolated from a renal transplant patient suffering from recurrent urosepsis over a period of 4 months. Imipenem resistance was detected after imipenem-ertapenem therapy. When treatment was switched to tigecycline the K. pneumoniae developed resistance to tigecycline (MIC = 8 mg/L). The nine isolates were tested by determination of agar dilution MICs, phenotypic carbapenemase, extended-spectrum beta-lactamases and metallo-beta-lactamase (MBL) testing and pulsed-field gel electrophoresis. Polymerase chain reaction and sequencing analysis were employed for identification of bla genes and mapping of the integron carrying the MBL gene. The nine isolates were clonally related and all produced the SHV-12 enzyme. Five MBL-producing isolates showed imipenem MICs ranging from 2 to 64 mg/L and all were detected by testing with imipenem and EDTA. The five isolates harboured the bla(VIM-1) gene. Three isolates showed increased tigecycline MICs (4-8 mg/L). Serial blood cultures obtained on the same day resulted in a VIM-positive/tigecycline-susceptible and a VIM-negative/tigecycline-resistant K. pneumoniae isolate. No isolate developed concurrent imipenem and tigecycline resistance. The patient had a persistent urinary tract infection and recurrent bacteraemia caused by a mixed population of Klebesiella pneumoniae isolates adapting to the selective pressure of antimicrobial therapy at the time. The present study is a worrisome example of what could happen when an immunocompromised host is subjected to the pressures of antimicrobial therapy. In addition, we report the first treatment-emergent MIC increase of tigecycline from 0.5 to 8 mg/L in K. pneumoniae.<br /> (© 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.)
- Subjects :
- Aged
Anti-Bacterial Agents pharmacology
Anti-Bacterial Agents therapeutic use
Bacterial Proteins genetics
Base Sequence
Chromosome Mapping
Cross Infection
Humans
Klebsiella Infections drug therapy
Klebsiella Infections microbiology
Klebsiella pneumoniae genetics
Klebsiella pneumoniae isolation & purification
Male
Microbial Sensitivity Tests
Minocycline pharmacology
Sequence Analysis, DNA
Tigecycline
Urinary Tract Infections drug therapy
Urinary Tract Infections microbiology
beta-Lactamases genetics
Carbapenems pharmacology
Drug Resistance, Multiple, Bacterial genetics
Kidney Transplantation
Klebsiella pneumoniae drug effects
Minocycline analogs & derivatives
Subjects
Details
- Language :
- English
- ISSN :
- 1469-0691
- Volume :
- 18
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 21722259
- Full Text :
- https://doi.org/10.1111/j.1469-0691.2011.03482.x