Multi-drug-resistant Klebsiella pneumoniae pancreatitis: a new challenge in a serious surgical infection.
BACKGROUND
Klebsiella pneumoniae is an important cause of nosocomial infections, but its role in severe acute pancreatitis (SAP) is not well defined. Few cases of K. pneumoniae associated SAP have been reported. Due to the emergence of extended-spectrum beta-lactamases (ESBLs) and carbapenemases, treatment of multidrug-resistant (MDR) K. pneumoniae presents a challenge. Tigecycline and colistin have gained recent attention for their broad-spectrum antimicrobial activity.


METHODS
We describe a case of SAP due to K. pneumoniae bearing K. pneumoniae carbapenemase (KPC) treated successfully with colistin plus tigecycline and offer a review of similar experiences published in the literature.


RESULTS
The case reported herein required surgical drainage of multiple pancreatic abscesses and treatment with tigecycline and colistin. Our comparative analysis revealed a number of unique features associated with SAP due to K. pneumoniae: 1) underlying pancreatic injury, 2) multiple drug resistance determinants and virulence factors that complicate treatment, and 3) surgical debridement as a requirement for cure.


CONCLUSIONS
As the prevalence of K. pneumoniae bearing KPC continues to increase in the healthcare setting, SAP caused by this MDR pathogen will become more common. Tigecycline plus colistin was a successful antibiotic regimen for the treatment of SAP due to K. pneumoniae bearing KPC.
1 Department of Medicine, University Hospitals Case Medical Center , Cleveland, Ohio.
Derin
D
Tugal
Melanie
M
Lynch
Andrea M
AM
Hujer
Susan
S
Rudin
Federico
F
Perez
Robert A
RA
Bonomo
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007710:Klebsiella Infections; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000472:pathogenicity; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents