Reactions 1704, p310 - 2 Jun 2018 Development of polymyxin B resistance in klebsiella pneumoniae infection: case report A 63-year-old man developed resistance to polymyxin B in treatment with Klebsiella pneumoniae infection [dosage not stated]. The man, who had poorly controlled diabetes mellitus, was hospitalised on 12 December 2016 for diarrhoea complicated by acute renal failure. He was noted to be unresponsive while travelling, and he was admitted to the ICU, on 22 December 2016. He developed fever, on 06 January 2017 (hospital day 15). Blood cultures were positive for carbapenem-resistant enterobacteriaceae (CRE) Klebsiella pneumoniae. These klebsiella pneumoniae cultures were observed to be susceptible to polymyxin B. He received treatment with a combination of IV polymyxin B and meropenem followed by IV tigecycline and polymyxin B. After two weeks of the therapy, he developed fever once again. Blood and urine cultures were positive for Klebsiella pneumoniae. The fever persisted despite the therapy with meropenem and polymyxin B. On 09 February 2017, Klebsiella blood cultures were found to be resistant to polymyxin B. The resistance pattern confirmed polymyxin B resistance with negative result for mobilised colistin resistance gene (MCR-1 gene). The man was treated with cotrimoxazole, which was subsequently changed to fosfomycin in view of deteriorating renal function. He developed renal abscess secondary to the Klebsiella infection. Following fosfomycin treatment, the infection resolved, and he was discharged. Author comment: "[R]esistance pattern revealed polymyxin resistance for which MCR-1 was negative." Chia P, et al. Successful treatment of CRE bacteremia and abscess with fosfomycin monotherapy with drainage. International Journal of Antimicrobial Agents 50 (Suppl. 1): S132 abstr. P2-CC11, Sep 2017. Available from: URL: https:// www.sciencedirect.com/science/article/pii/S0924857917303424 [abstarct] - Singapore 803323926 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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