title: Successful treatment of a disseminated infection with extensively drug-resistant Klebsiella pneumoniae in a liver transplant recipient with a fosfomycin-based multidrug regimen.
abstract: Donor-derived infections with multidrug-resistant gram-negative bacteria are associated with poor outcomes, in part because of limited treatment options. Here, we describe a case of donor-derived, disseminated infection with colistin-resistant, carbapenemase-producing Klebsiella pneumoniae in a liver transplant recipient that was cured with addition of intravenous fosfomycin to a multidrug regimen, in conjunction with aggressive surgical source control. Intravenous fosfomycin represents a promising adjunctive agent for use in treatment of extensively drug-resistant infections in immunocompromised hosts.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA. millsjo@umich.edu.
authors.forename: J P
authors.initials: JP
authors.lastname: Mills
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Wilck
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: B C
authors.initials: BC
authors.lastname: Weikert
authors.affiliation: Division of Transplant Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Porrett
authors.affiliation: Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: D
authors.initials: D
authors.lastname: Timko
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: K
authors.initials: K
authors.lastname: Alby
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Research Service, Cleveland, Ohio, USA.|Departments of Medicine, Pharmacology, and Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Bonomo
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Blumberg
mesh_terms: D000368:Aged; D064591:Allografts / Q000382:microbiology*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001426:Bacterial Proteins / Q000378:metabolism; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005355:Fibrosis / Q000601:surgery*; D005578:Fosfomycin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000209:etiology; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000302:isolation & purification / Q000502:physiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008826:Microbial Sensitivity Tests; D008911:Minocycline / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000078304:Tigecycline; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D005578:Fosfomycin; D000078304:Tigecycline; D001618:beta-Lactamases; C063912:carbapenemase; D008911:Minocycline; D003091:Colistin
keywords: carbapenem-resistant Klebsiella pneumoniae (CRKP); extremely drug-resistant (XDR); fosfomycin; orthotopic liver transplantation (OLT)