title: Emergence of concurrent infections with colistin-resistant ESBL-positive Klebsiella pneumoniae and OXA-23-producing Acinetobacter baumannii sensitive to colistin only in a Romanian cardiac intensive care unit.
abstract: We report the emergence and analysis of a cluster of concurrent infections/colonisations with colistin-resistant Klebsiella pneumoniae and OXA-23 carbapenemase-producing Acinetobacter baumannii in patients who had undergone cardiac surgery. We describe the emergence of colistin-resistant K. pneumoniae harbouring blaCTX-M-15, blaSHV-11, blaOXA-1, blaTEM-1 beta-lactamases and aac(6')-Ib-cr fluoroquinolone resistance. Colistin-resistant K. pneumoniae infections (pneumonia, wound infection, urinary tract infections and bacteraemia) occurred in critically ill patients previously treated with colistin for post-surgery infections with carbapenem-resistant Pseudomonas aeruginosa and/or A. baumannii. Although the cause of death could not be directly attributed to a single pathogen, three patients co-infected/colonised with K. pneumoniae, P. aeruginosa and/or A. baumannii died, whilst a fourth patient who had a mono-microbial infection with colistin-resistant K. pneumoniae only survived. The use of mobile intubation equipment in patients that shared the same ward, the clustering of cases over a short period of time, as well as the pulsed-field gel electrophoresis (PFGE) data all suggest cross-contamination between patients, either through equipment or by staff contact transmission. This report presents the 'worst-case scenario' where concurrent infection/colonisation with pathogens exhibiting resistance to different types of last-resort antimicrobials occurred in some of the most debilitated intensive care unit (ICU) patients.
authors.affiliation: School of Veterinary Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, CH64 7TE, UK. d.timofte@liv.ac.uk.|Faculty of Veterinary Medicine, University of Agronomical Sciences and Veterinary Medicine, Iasi, Romania. d.timofte@liv.ac.uk.|Institute of Infection and Global Health, University of Liverpool, Liverpool, UK. d.timofte@liv.ac.uk.
authors.forename: D
authors.initials: D
authors.lastname: Timofte
authors.affiliation: Institute of Cardiovascular Diseases, Iasi, Romania.
authors.forename: M
authors.initials: M
authors.lastname: Dan
authors.affiliation: School of Veterinary Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, CH64 7TE, UK.|Faculty of Veterinary Medicine, University of Agronomical Sciences and Veterinary Medicine, Iasi, Romania.
authors.forename: I E
authors.initials: IE
authors.lastname: Maciuca
authors.affiliation: Institute of Cardiovascular Diseases, Iasi, Romania.
authors.forename: L
authors.initials: L
authors.lastname: Ciucu
authors.affiliation: Institute of Cardiovascular Diseases, Iasi, Romania.
authors.forename: E R
authors.initials: ER
authors.lastname: Dabija
authors.affiliation: Faculty of Veterinary Medicine, University of Agronomical Sciences and Veterinary Medicine, Iasi, Romania.
authors.forename: E
authors.initials: E
authors.lastname: Guguianu
authors.affiliation: Institute of Cardiovascular Diseases, Iasi, Romania.|University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania.
authors.forename: C V
authors.initials: CV
authors.lastname: Panzaru
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000235:genetics; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data; D003091:Colistin / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects / Q000235:genetics; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007710:Klebsiella Infections / Q000188:drug therapy*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000235:genetics; D008297:Male; D008826:Microbial Sensitivity Tests; D011552:Pseudomonas Infections / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000235:genetics; D012383:Romania
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin