Successful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam

Abstract 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 infect...

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Autores principales:	Majed F. Alghoribi, Moayad Alqurashi, Liliane Okdah, Bassam Alalwan, Yahya S. AlHebaishi, Abdulmajeed Almalki, Maha A. Alzayer, Abdulrahman A. Alswaji, Michel Doumith, Mazin Barry
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/cbf960f3bb824ed6b694d0c476029956
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spelling	oai:doaj.org-article:cbf960f3bb824ed6b694d0c4760299562021-12-02T14:49:26ZSuccessful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam10.1038/s41598-021-89255-82045-2322https://doaj.org/article/cbf960f3bb824ed6b694d0c4760299562021-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-89255-8https://doaj.org/toc/2045-2322Abstract 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.Majed F. AlghoribiMoayad AlqurashiLiliane OkdahBassam AlalwanYahya S. AlHebaishiAbdulmajeed AlmalkiMaha A. AlzayerAbdulrahman A. AlswajiMichel DoumithMazin BarryNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Majed F. Alghoribi Moayad Alqurashi Liliane Okdah Bassam Alalwan Yahya S. AlHebaishi Abdulmajeed Almalki Maha A. Alzayer Abdulrahman A. Alswaji Michel Doumith Mazin Barry Successful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam
description	Abstract 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.
format	article
author	Majed F. Alghoribi Moayad Alqurashi Liliane Okdah Bassam Alalwan Yahya S. AlHebaishi Abdulmajeed Almalki Maha A. Alzayer Abdulrahman A. Alswaji Michel Doumith Mazin Barry
author_facet	Majed F. Alghoribi Moayad Alqurashi Liliane Okdah Bassam Alalwan Yahya S. AlHebaishi Abdulmajeed Almalki Maha A. Alzayer Abdulrahman A. Alswaji Michel Doumith Mazin Barry
author_sort	Majed F. Alghoribi
title	Successful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam
title_short	Successful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam
title_full	Successful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam
title_fullStr	Successful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam
title_full_unstemmed	Successful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam
title_sort	successful treatment of infective endocarditis due to pandrug-resistant klebsiella pneumoniae with ceftazidime-avibactam and aztreonam
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/cbf960f3bb824ed6b694d0c476029956
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Successful treatment of infective endocarditis due to pandrug-resistant Klebsiella pneumoniae with ceftazidime-avibactam and aztreonam

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