[First isolation of metallo-beta-lactamase producing Klebsiella pneumoniae strain in Poland].
BACKGROUND
Metallo-beta-lactamases (MBL) are the enzymes that are able to hydrolyse almost the full range of beta-lactame antibiotics--penicillins, cephalosporins and carbapenems. The latter are the drugs of choice for treatment of serious infections caused by Enterobacteriaceae strains, which produce extended-spectrum-beta-lactamases. The presence of MBL-producing strains markedly decreases the therapeutic possibilities in severe, life-threatening infections.


METHODS
We present the case of a 61-yr-old man who underwent surgery for acute leg ischemia, and in whom a bifurcation prosthesis was implanted. The postoperative course was complicated with serious nosocomial infection, caused by MBL-positive Klebsiella pneumoniae strains. Despite multi drug treatment and intensive care, the patient died 30 days after surgery due to multi organ failure. All isolates cultured from the patient were resistant to carbapenems with their MICs exceeding 32 microg mL(-1). The presence of MBLs was detected with the double-disk synergy test. The presence of genes encoding MBLs was determined with a commercial kit, hyplex MBL ID (Bag Health Care, USA). The isolate from blood was found to carry the blaVIM-like family gene, located in a conjugative plasmid.


CONCLUSIONS
The MBL-producing isolates were the first K. pneumoniae isolates of the kind identified in Poland. They present a serious danger, limiting the usefulness of carbapenems in ITU patients. We recommend that detection of MBLs in Enterobacteriaceae should be regarded as a standard in Polish hospitals.
Sekowska
Alicja
A
Zakład Mikrobiologii, Collegium Medicum UMK w Bydgoszczy.
Gospodarek
Eugenia
E
Kruszyńska
Ewa
E
Hryniewicz
Waleria
W
Gniadkowski
Marek
M
Duljasz
Wojciech
W
Kusza
Krzysztof
K
Wawrzyniak
Katarzyna
K
D001807:Blood Vessel Prosthesis; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy*; D018432:Drug Resistance, Multiple; D017809:Fatal Outcome; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007710:Klebsiella Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology* / Q000302:isolation & purification*; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects; D013045:Species Specificity; D001618:beta-Lactamases / Q000096:biosynthesis
D001618:beta-Lactamases; C482458:metallo-beta-lactamase VIM-4, Klebsiella pneumoniae