Successful treatment of a disseminated infection with extensively drug-resistant Klebsiella pneumoniae in a liver transplant recipient with a fosfomycin-based multidrug regimen

J P Mills; M B Wilck; B C Weikert; P M Porrett; D Timko; K Alby; R A Bonomo; E A Blumberg

doi:10.1111/tid.12578

Successful treatment of a disseminated infection with extensively drug-resistant Klebsiella pneumoniae in a liver transplant recipient with a fosfomycin-based multidrug regimen

Transpl Infect Dis. 2016 Oct;18(5):777-781. doi: 10.1111/tid.12578. Epub 2016 Sep 7.

Authors

J P Mills¹, M B Wilck², B C Weikert², P M Porrett³, D Timko⁴, K Alby⁵, R A Bonomo^{6

7}, E A Blumberg²

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA. [email protected].
² Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
³ Division of Transplant Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
⁴ Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵ Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
⁶ Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Research Service, Cleveland, Ohio, USA.
⁷ Departments of Medicine, Pharmacology, and Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, USA.

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.

Keywords: carbapenem-resistant Klebsiella pneumoniae (CRKP); extremely drug-resistant (XDR); fosfomycin; orthotopic liver transplantation (OLT).

Publication types

Case Reports

MeSH terms

Aged
Allografts / microbiology*
Anti-Bacterial Agents / administration & dosage
Anti-Bacterial Agents / therapeutic use*
Antibiotic Prophylaxis
Bacterial Proteins / metabolism
Colistin / administration & dosage
Colistin / therapeutic use
Drug Resistance, Multiple, Bacterial*
Drug Therapy, Combination / methods
Female
Fibrosis / surgery*
Fosfomycin / administration & dosage
Fosfomycin / therapeutic use
Humans
Klebsiella Infections / drug therapy*
Klebsiella Infections / etiology
Klebsiella pneumoniae / enzymology
Klebsiella pneumoniae / isolation & purification
Klebsiella pneumoniae / physiology*
Liver Transplantation / adverse effects*
Microbial Sensitivity Tests
Minocycline / administration & dosage
Minocycline / analogs & derivatives
Minocycline / therapeutic use
Tigecycline
beta-Lactamases / metabolism

Substances

Anti-Bacterial Agents
Bacterial Proteins
Fosfomycin
Tigecycline
beta-Lactamases
carbapenemase
Minocycline
Colistin

Abstract

Publication types

MeSH terms

Substances

Grants and funding