Successful treatment of a Carbapenem-resistant Klebsiella pneumoniae carrying blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV- with high dose combination of imipenem and amikacin
We describe a case of 58-year-old man with septic shock due to Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) bloodstream infections (BSI) who was successfully treated with a high dose association of amikacin and imipenem combined with continuous venovenous hemodiafiltration (CVVHDF). A Klebsiel...
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doaj-1c8cd9a902eb48f6a4dbacece37cf1782021-07-02T05:58:44ZengElsevierIDCases2214-25092016-01-014C101210.1016/j.idcr.2016.01.003Successful treatment of a Carbapenem-resistant Klebsiella pneumoniae carrying blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV- with high dose combination of imipenem and amikacinZied Hajjej0Hedi Gharsallah1Habiba Naija2Ilhem Boutiba3Iheb Labbene4Mustapha Ferjani5Intensive Care Unit, Military Hospital of Tunis, Montfleury, 1008 Tunis, TunisiaIntensive Care Unit, Military Hospital of Tunis, TunisiaMilitary Hospital of Tunis, TunisiaLaboratory of Research “resistance to antibiotics” Faculty of Medicine of Tunis, TunisiaIntensive Care Unit, Military Hospital of Tunis, TunisiaHead of Department of Intensive Care Unit, Military Hospital of Tunis, TunisiaWe describe a case of 58-year-old man with septic shock due to Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) bloodstream infections (BSI) who was successfully treated with a high dose association of amikacin and imipenem combined with continuous venovenous hemodiafiltration (CVVHDF). A Klebsiella pneumoniae (Kp) was isolated from the catheter culture and from two blood samples, drawn from the catheter before removal and from a peripheral vein. The Kp was intermediate to Amikacin (MIC = 16 μg/ml) and was resistant to all other antibiotics including Imipenem (MIC = 4 μg/ml), Colistin (MIC = 16 μg/ml) and Tigecycline (MIC = 4 μg/ml) according to the Clinical and Laboratory Standards Institute (CLSI) published in 2011. PCR amplification and sequencing verified the presence of blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV-1 genes. Amikacin was given at a dose of 30 mg/kg (2.5 g) in a 30 min infusion and the dose of imipenem was increased to 1 g every 6 h despite patient's altered renal function (Creatinine Clearance = 25 ml/min). To avoid amikacin nephrotoxicity and to allow the use of high doses of imipenem, continuous venovenous hemodiafiltration (CVVHDF) (blood flow, 200 ml/h; dialysate, 1000 ml/h; ultrafiltrate, 2000 ml/h) was initiated 1 h after the start of the amikacin infusion and continued thereafter. The patient improved hemodynamically and norepinephrine was stopped five days after antibiotherapy adaptation.http://www.sciencedirect.com/science/article/pii/S2214250916000044Carbapenem-resistant Klebsiella pneumoniaeBloodstream infectionsContinuous venovenous hemodiafiltration |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Zied Hajjej Hedi Gharsallah Habiba Naija Ilhem Boutiba Iheb Labbene Mustapha Ferjani |
spellingShingle |
Zied Hajjej Hedi Gharsallah Habiba Naija Ilhem Boutiba Iheb Labbene Mustapha Ferjani Successful treatment of a Carbapenem-resistant Klebsiella pneumoniae carrying blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV- with high dose combination of imipenem and amikacin IDCases Carbapenem-resistant Klebsiella pneumoniae Bloodstream infections Continuous venovenous hemodiafiltration |
author_facet |
Zied Hajjej Hedi Gharsallah Habiba Naija Ilhem Boutiba Iheb Labbene Mustapha Ferjani |
author_sort |
Zied Hajjej |
title |
Successful treatment of a Carbapenem-resistant Klebsiella pneumoniae carrying blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV- with high dose combination of imipenem and amikacin |
title_short |
Successful treatment of a Carbapenem-resistant Klebsiella pneumoniae carrying blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV- with high dose combination of imipenem and amikacin |
title_full |
Successful treatment of a Carbapenem-resistant Klebsiella pneumoniae carrying blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV- with high dose combination of imipenem and amikacin |
title_fullStr |
Successful treatment of a Carbapenem-resistant Klebsiella pneumoniae carrying blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV- with high dose combination of imipenem and amikacin |
title_full_unstemmed |
Successful treatment of a Carbapenem-resistant Klebsiella pneumoniae carrying blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV- with high dose combination of imipenem and amikacin |
title_sort |
successful treatment of a carbapenem-resistant klebsiella pneumoniae carrying blaoxa-48, blavim-2, blacmy-2 and blashv- with high dose combination of imipenem and amikacin |
publisher |
Elsevier |
series |
IDCases |
issn |
2214-2509 |
publishDate |
2016-01-01 |
description |
We describe a case of 58-year-old man with septic shock due to Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) bloodstream infections (BSI) who was successfully treated with a high dose association of amikacin and imipenem combined with continuous venovenous hemodiafiltration (CVVHDF).
A Klebsiella pneumoniae (Kp) was isolated from the catheter culture and from two blood samples, drawn from the catheter before removal and from a peripheral vein. The Kp was intermediate to Amikacin (MIC = 16 μg/ml) and was resistant to all other antibiotics including Imipenem (MIC = 4 μg/ml), Colistin (MIC = 16 μg/ml) and Tigecycline (MIC = 4 μg/ml) according to the Clinical and Laboratory Standards Institute (CLSI) published in 2011. PCR amplification and sequencing verified the presence of blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV-1 genes.
Amikacin was given at a dose of 30 mg/kg (2.5 g) in a 30 min infusion and the dose of imipenem was increased to 1 g every 6 h despite patient's altered renal function (Creatinine Clearance = 25 ml/min). To avoid amikacin nephrotoxicity and to allow the use of high doses of imipenem, continuous venovenous hemodiafiltration (CVVHDF) (blood flow, 200 ml/h; dialysate, 1000 ml/h; ultrafiltrate, 2000 ml/h) was initiated 1 h after the start of the amikacin infusion and continued thereafter.
The patient improved hemodynamically and norepinephrine was stopped five days after antibiotherapy adaptation. |
topic |
Carbapenem-resistant Klebsiella pneumoniae Bloodstream infections Continuous venovenous hemodiafiltration |
url |
http://www.sciencedirect.com/science/article/pii/S2214250916000044 |
work_keys_str_mv |
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