title: Open Conversion after Aortic Endograft Infection Caused by Colistin-Resistant, Carbapenemase-Producing Klebsiella pneumoniae.
abstract: A 62-year-old man presented with fever, abdominal pain, and malaise 13 months after emergency endovascular aortic repair. Computed tomographic angiograms showed a periprosthetic fluid and gas collection, so infection was diagnosed. Open conversion was performed, involving endograft explantation and in situ aortic reconstruction. Cultures and the explanted prosthesis were positive for carbapenemase-producing Klebsiella pneumoniae, resistant to colistin. Because of the sparse data on endograft infections caused by this pathogen, we placed the patient on an empiric double-carbapenem regimen for 4 weeks. Symptomatic recovery occurred after 21 days. On the 30th day, we deployed a stent to treat a new pseudoaneurysm. Three years later, the patient had no signs of persistent or recurrent infection. We think that this is the first report of aortic endograft infection caused by colistin-resistant, carbapenemase-producing K. pneumoniae.
authors: Nunzio
authors: N
authors: Montelione
authors: Danilo
authors: D
authors: Menna
authors: Pasqualino
authors: P
authors: Sirignano
authors: Laura
authors: L
authors: Capoccia
authors: Wassim
authors: W
authors: Mansour
authors: Francesco
authors: F
authors: Speziale
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001426:Bacterial Proteins / Q000378:metabolism*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D015780:Carbapenems / Q000627:therapeutic use*; D003091:Colistin; D000072226:Computed Tomography Angiography; D020878:Device Removal; D024881:Drug Resistance, Bacterial; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007710:Klebsiella Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase; D003091:Colistin
keywords: Anti-bacterial agents/therapeutic use; Klebsiella pneumoniae/drug effects/growth & development; aortic aneurysm, abdominal/surgery; bacterial infections/drug therapy/etiology/microbiology; blood vessel prosthesis implantation/adverse effects; drug therapy, combination; endovascular procedures/adverse effects; postoperative complications; prosthesis-related infections/diagnosis/drug therapy/microbiology/surgery; treatment outcome