Fatal cross infection by carbapenem-resistant Klebsiella in two liver transplant recipients.
Members of the family Enterobacteriaceae including Klebsiella have re-emerged as major pathogens in solid organ transplantation. The recent appearance and dissemination of carbapenemase-producing Enterobacteriaceae in Europe and the northeastern United States represents a major challenge to the treatment of enteric gram-negative bacterial infections in immunocompromised patients; however, few reports have detailed the outcomes of such infections. Here we report 2 cases of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella infections in orthotopic liver transplant recipients, which were the index case and initial secondary case for an outbreak of KPC-producing Enterobacteriaceae in our institution. In both instances, the pathogens were initially misidentified as being carbapenem sensitive, the infections recurred after cessation of directed therapy, and the patients ultimately succumbed to their infections.
Mathers
A J
AJ
Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
Cox
H L
HL
Bonatti
H
H
Kitchel
B
B
Brassinga
A K C
AK
Wispelwey
B
B
Sawyer
R G
RG
Pruett
T L
TL
Hazen
K C
KC
Patel
J B
JB
Sifri
C D
CD
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000096:biosynthesis; D015780:Carbapenems / Q000494:pharmacology*; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D001618:beta-Lactamases / Q000096:biosynthesis
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase