title: Fatal cross infection by carbapenem-resistant Klebsiella in two liver transplant recipients.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Mathers
authors.forename: H L
authors.initials: HL
authors.lastname: Cox
authors.forename: H
authors.initials: H
authors.lastname: Bonatti
authors.forename: B
authors.initials: B
authors.lastname: Kitchel
authors.forename: A K C
authors.initials: AK
authors.lastname: Brassinga
authors.forename: B
authors.initials: B
authors.lastname: Wispelwey
authors.forename: R G
authors.initials: RG
authors.lastname: Sawyer
authors.forename: T L
authors.initials: TL
authors.lastname: Pruett
authors.forename: K C
authors.initials: KC
authors.lastname: Hazen
authors.forename: J B
authors.initials: JB
authors.lastname: Patel
authors.forename: C D
authors.initials: CD
authors.lastname: Sifri
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase