title: Successful Treatment of Urinary Tract Infection in Kidney Transplant Recipients Caused by Multiresistant Klebsiella pneumoniae Producing New Delhi Metallo-Beta-Lactamase (NDM-1) With Strains Genotyping.
abstract: BACKGROUND
  Klebsiella pneumoniae New Delhi metallo-beta-lactamase-1 (NDM-1) strains have recently become a new threat in kidney transplant recipients due to the strains' resistance to almost all antibiotics, including carbapenems.
  
  
  METHODS
  We present a case series of 3 patients with urinary tract infections (UTIs) caused by multiresistant K pneumoniae NDM-1 strains who were treated with the same protocol. Genotyping sequencing with pulsed-field gel electrophoresis was performed in all cases.
  
  
  RESULTS
  All patients were male and had undergone kidney transplantation 4, 7, and 8 months, respectively, before the admission. Combined antibiotic therapy consisting of imipenem/cilastatin in maximal doses, gentamicin and/or colistin for 21 to 27 days, followed by oral fosfomycin, was used in all cases. There were no further UTI episodes in 2 patients at the 12-month visit. Three months after initial treatment, the third patient presented with leukocyturia with no clinical symptoms and a urine culture positive for K pneumonia NDM-1 strain. Interestingly, the strain was susceptible to trimethoprim/sulfamethoxazole despite resistance in previous urine culture samples. The patient was successfully treated with trimethoprim/sulfamethoxazole 2 × 960 mg/d for 3 weeks followed by 480 mg/d and 3 doses of fosfomycin. Genotyping sequencing revealed identical DNA restriction fragments in bacterial strains from 2 patients. In the third case, although a difference in 2 restriction fragments was observed, the strain was considered related to the others.
  
  
  CONCLUSIONS
  In cases of UTI caused by K pneumoniae NDM-1 strains, prolong combined treatment followed by oral fosfomycin prophylaxis can be successful. Strain genotyping should be performed to optimize further treatment protocols in such cases.
authors: Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors: P
authors: P
authors: Wilkowski
authors: Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland. Electronic address: mciszek@onet.pl.
authors: M
authors: M
authors: Ciszek
authors: Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland.
authors: K
authors: K
authors: Dobrzaniecka
authors: Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors: J
authors: J
authors: Sańko-Resmer
authors: Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors: A
authors: A
authors: Łabuś
authors: Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland.
authors: K
authors: K
authors: Grygiel
authors: Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland.
authors: T
authors: T
authors: Grochowiecki
authors: Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland.
authors: G
authors: G
authors: Młynarczyk
authors: Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors: L
authors: L
authors: Pączek
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015377:Cilastatin / Q000627:therapeutic use; D000077728:Cilastatin, Imipenem Drug Combination; D003091:Colistin / Q000627:therapeutic use; D004338:Drug Combinations; D004352:Drug Resistance, Microbial; D016521:Electrophoresis, Gel, Pulsed-Field; D005578:Fosfomycin / Q000627:therapeutic use; D005838:Genotype; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D016030:Kidney Transplantation; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000235:genetics; D007711:Klebsiella pneumoniae / Q000235:genetics; D008297:Male; D008826:Microbial Sensitivity Tests; D066027:Transplant Recipients; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D005839:Gentamicins; D015377:Cilastatin; D005578:Fosfomycin; D015378:Imipenem; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000077728:Cilastatin, Imipenem Drug Combination; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1; D003091:Colistin