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
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Publicado: Nature Portfolio 2021
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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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