title: Ventilator-associated pneumonia caused by colistin-resistant KPC-producing Klebsiella pneumoniae: a case report and literature review.
abstract: Klebsiella pneumoniae producing KPC-type carbapenemase causes severe nosocomial infection at a high mortality rate. Nosocomial pneumonia in particular is associated with high mortality, likely due to the unfavorable pulmonary pharmacokinetics of the antibiotics used against this agent. Therefore, early and accurate microbiological identification and susceptibility evaluation are crucial in order to optimize antibiotic therapy. We report a case of ventilator-associated pneumonia caused by colistin-resistant K. pneumoniae producing KPC-type carbapenemase treated using a carbapenem-sparing therapy and tailored according to the serum procalcitonin concentration in order to limit the duration of antibiotic therapy.
authors.affiliation: Anestesia, Terapia Intensiva e Sub-Intensiva Neuromuscoloscheletrica, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla, Firenze 50134, Italy. Electronic address: bruno.viaggi@gmail.it.
authors.forename: Bruno
authors.initials: B
authors.lastname: Viaggi
authors.affiliation: Fondazione Toscana Gabriele Monasterio, Via G. Moruzzi, 1, Pisa 56124, Italy. Electronic address: francesco.sbrana@ftgm.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sbrana
authors.affiliation: U.O. Anestesia e Rianimazione 6°, Azienda Ospedaliera Universitaria Pisana, Via Paradisa, Pisa 56124, Italy. Electronic address: pmalacarne@hotmail.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Malacarne
authors.affiliation: U.O. Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Via Paradisa, Pisa 56124, Italy. Electronic address: carlo.tascini@libero.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tascini
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001426:Bacterial Proteins / Q000096:biosynthesis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D003091:Colistin / Q000008:administration & dosage / Q000031:analogs & derivatives; D003428:Cross Infection / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D004866:Equipment Contamination; D005578:Fosfomycin / Q000008:administration & dosage; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification / Q000378:metabolism / Q000472:pathogenicity*; D008297:Male; D008911:Minocycline / Q000008:administration & dosage / Q000031:analogs & derivatives; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology*; D011498:Protein Precursors / Q000097:blood; D000078304:Tigecycline; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000009:adverse effects* / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C000606589:CALCA protein, human; D011498:Protein Precursors; D005578:Fosfomycin; D000078304:Tigecycline; D002116:Calcitonin; C004691:colistinmethanesulfonic acid; D001618:beta-Lactamases; C063912:carbapenemase; D008911:Minocycline; D015740:Calcitonin Gene-Related Peptide; D003091:Colistin
keywords: Colistin-resistant KPC producing Klebsiella pneumoniae; Drug pharmacokinetics; Intensive care unit; Ventilator-associated pneumonia