Intestinal decontamination of multidrug-resistant Klebsiella pneumoniae after recurrent infections in an immunocompromised host

Matthew P Kronman, Danielle M Zerr, Xuan Qin, Janet Englund, Cathy Cornell, Jean E Sanders, Jeffrey Myers, Jaipreet Rayar, Jessica E Berry, Amanda L Adler, Scott J Weissman, Matthew P Kronman, Danielle M Zerr, Xuan Qin, Janet Englund, Cathy Cornell, Jean E Sanders, Jeffrey Myers, Jaipreet Rayar, Jessica E Berry, Amanda L Adler, Scott J Weissman

Abstract

Multidrug-resistant (MDR) Enterobacteriaceae infections are associated with increased morbidity. We describe a 20-year-old hematopoietic cell transplantation recipient with recurrent MDR Klebsiella pneumoniae infection, prolonged intestinal colonization, and subsequent intestinal decontamination. Further study should evaluate stool surveillance, molecular typing, and fecal microbiota transplantation for patients with intestinal MDR Enterobacteriaceae carriage.

Keywords: Hematopoietic cell transplantation; Intestinal decontamination; Klebsiella pneumoniae; Pediatrics; Resistance.

Conflict of interest statement

Conflict of Interest

SJW is party to a patent application describing a point-of-care diagnostic test to optimize selection of initial antibiotics in urinary tract infection. The method remains in the developmental stage, and SJW has received no financial compensation for or benefit from the patented entity. He has also received grant funding from Pfizer to study Antimicrobial Stewardship Program effectiveness at US children’s hospitals. None of the other authors reports a significant financial conflict of interest relevant to this work.

Copyright © 2014 Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Timeline of Antibiotic Exposures and K. pneumoniae Clones by Resistance and Body Site, through day 750. B – blood, CR – carbapenem resistance phenotype, ESBL – Extended-spectrum beta-lactam resistance phenotype, K – knee, S – stool, U – urine, W – wound. Solid squares represent surveillance stool cultures positive for resistant K. pneumoniae; open squares represent surveillance stool cultures negative for resistant K. pneumoniae. Resistance profiles for each surveillance isolate are provided above the surveillance isolates, by clone. * - This surveillance culture was negative for resistant K. pneumoniae but positive for carbapenem-resistant E. coli.
Figure 2
Figure 2
Clinical and molecular features of sterile and non-sterile site isolates of K. pneumoniae recovered from a single patient. Day, day of clinical course (as described in text). Site, clinical specimen: W, wound; S, stool; B, blood; K, knee; U, urine. R genes, resistance genes (includes plasmid-associated cephalosporinases and chromosome-associated ampicillinases). ST, sequence type. wt, wild type proteins or residues. For GyrA, ParC, wild type amino acid residues in Quinolone Resistance Determining Regions are S83 (GyrA) and S80 (ParC). NEG, negative by PCR. trunc, truncated due to sequence polymorphism. MER, meropenem susceptibility. S, susceptible. R, resistant.

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Source: PubMed

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