title: Urinary tract infection caused by carbapenem-resistant K. pneumoniae and P. aeruginosa.
abstract: There has been an increase in recent years of antimicrobial resistance of Gram negative bacilli (GNB). Carbapenems, the mainstay for the treatment of multidrug resistant GNB infections, are no longer always effective leaving treatment options limited. We present the case of patient with recurrent, complicated urinary tract infections. The current episode was caused by carbapenem-resistant K. pneumoniae and P. aeruginosa and carbapenem-susceptible, but MDR E. cloacae. Resistance to carbapenems of K. pneumoniae was conferred by the production of the class B metallo-beta-lactamase, VIM1. Infection control measures were implemented and following a 2-week course of treatment with colistin, the infection resolved and the patient was discharged. We discuss the changes in the epidemiology, the mechanisms involved and the means of detecting carbapenem resistance in GNB. We would also like to stress the role of infection control measures in limiting patient-to-patient spread of MDR organisms which, are of paramount importance in cases when few treatment options are left available.
authors.affiliation: Prof. Dr. Matei Balş National Institute of Infectious Diseases, Bucharest, Romania. ioanad_olaru@yahoo.co.uk
authors.forename: Ioana D
authors.initials: ID
authors.lastname: Olaru
authors.forename: Mona
authors.initials: M
authors.lastname: Popoiu
authors.forename: J
authors.initials: J
authors.lastname: Breuil
authors.forename: Victoria
authors.initials: V
authors.lastname: Aramă
authors.forename: Adriana
authors.initials: A
authors.lastname: Hristea
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D015780:Carbapenems / Q000008:administration & dosage*; D003091:Colistin / Q000008:administration & dosage; D024901:Drug Resistance, Multiple, Bacterial; D016972:Enterobacter cloacae / Q000302:isolation & purification / Q000472:pathogenicity; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000635:transmission; D006801:Humans; D017053:Infection Control; D007710:Klebsiella Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000302:isolation & purification / Q000472:pathogenicity; D008297:Male; D053040:Nephrolithiasis / Q000150:complications; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012307:Risk Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000601:surgery; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000635:transmission; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D003091:Colistin