colistin and Abdominal-Abscess

Five carbapenem-resistant strains (three Klebsiella pneumoniae, one Escherichia coli, and one Enterobacter aerogenes) were isolated between 2009 and 2012 at the Verona University Hospital, Italy, during an epidemiological analysis of antibiotic resistance determinants and plasmid profiles in Enterobacteriaceae. Two out of the five strains, K. pneumoniae E530 and E. coli E558, were cultured from bile and abdominal drainage, respectively, of a single patient. The strains were resistant to beta-lactams and fluoroquinolones, and susceptible to tigecycline and colistin. All the strains harboured bla(KPC-3), bla(TEM-1), and bla(OXA-9), and the three K. pneumoniae additionally carried blaSHV-11 and aac(6')Ib. The bla(KPC-3) was inserted in transposon Tn4401a. All the strains hosted an FIIk-type plasmid, and the three K. pneumoniae coharboured an colE-type plasmid. Transconjugants, besides bla(KPC-3), harboured bla(TEM-1) and bla(OXA-9) genes on FIIk-type plasmid. K. pneumoniae E301 was ST258, while strain E530 and C525 belonged to the ST512, and E. coli E558 was ST43. To our best knowledge, this is the first report that strongly supports the transmission of bla(KPC-3) from ST512 K. pneumoniae to E. coli ST43 in a single patient, a phenomenon of both clinical and microbiological importance.

Topics: Abdominal Abscess; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; beta-Lactams; Bile; Colistin; Conjugation, Genetic; DNA Transposable Elements; Drug Resistance, Multiple, Bacterial; Enterobacter aerogenes; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Gene Expression; Humans; Klebsiella Infections; Klebsiella pneumoniae; Minocycline; Plasmids; Tigecycline

Knowledge of the etiology of pyogenic liver and pancreatic abscesses is an important factor in determining the success of combined surgical and antibiotic treatment. Literature shows geographical variations in the prevalence and distribution of causative organisms, and the spread of Klebsiella pneumoniae carbapenemase-producing bacteria is an emerging cause of abdominal infections.. We herein describe two cases of intra-abdominal abscesses due to monomicrobial infection by Klebsiella pneumoniae Sequence Type 258 producing K. pneumoniae carbapenemase 3 (KPC-Kp). In case 1, a 50-year-old HIV-negative Italian woman with chronic pancreatitis showed infection of a pancreatic pseudocystic lesion caused by KPC-Kp. In case 2, a 64-year-old HIV-negative Italian woman with pancreatic neoplasm and liver metastases developed a liver abscess due to KPC after surgery. Both women were admitted to our hospital but to different surgical units. The clonal relationship between the two isolates was investigated by pulsed-field gel electrophoresis (PFGE). In case 2, the patient was already colonized at admission and inter-hospital transmission of the pathogen was presumed. A long-term combination regimen of colistin with tigecycline and percutaneous drainage resulted in full recovery and clearance of the multidrug-resistant (MDR) pathogen.. Timely microbiological diagnosis, the combined use of new and old antibiotics and radiological intervention appeared to be valuable in managing these serious conditions. The emergence and dissemination of MDR organisms is posing an increasing challenge for physicians to develop new therapeutic strategies and control and prevention frameworks.

Topics: Abdominal Abscess; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Colistin; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Neoplasms; Middle Aged; Minocycline; Pancreatic Neoplasms; Pancreatitis, Chronic; Tigecycline

Achromobacter xylosoxidans (formerly Alcaligenes xylosoxidans) is a rare but important nosocomial pathogen. Antibiotic resistance has been increasing during the past decade. A. xylosoxidans may be confused with Pseudomonas spp. but, unlike Pseudomonas spp., this organism has peritrichous flagella. Complicated intra-abdominal infection with A. xylosoxidans has rarely been reported in the literature. This report is of an immunocompetent patient with acute cholecystitis complicated by an intra-abdominal abscess after surgery. Culture of both blood and ascites yielded extended drug-resistant A. xylosoxidans, which was only sensitive to colistin. The clinical and laboratory characteristics of A. xylosoxidans are presented.

Topics: Abdominal Abscess; Achromobacter denitrificans; Adult; Anti-Bacterial Agents; Ascites; beta-Lactamases; Blood; Cholecystitis; Colistin; Cross Infection; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacterial Infections; Humans; Male

Multidrug resistant Gram-negative rods are emerging as major pathogens and are the cause of difficulty to treat infections. In certain situations colistin is the only active drug.. A retrospective review of the patient's charts admitted at Hôtel-Dieu de France hospital, Beirut, between October 2002 and February 2004 and treated with intravenous colistin.. Fifteen patients were identified; they were suffering from urinary tract infections, cellulitis, osteomyelitis, mediastinitis and intra-abdominal abscess. The microorganisms were resistant to all available antibiotics except colistin. Three strains were also susceptible to aminoglycosides. Pseudomonas aeruginosa was the most frequently isolated pathogen. Colistin was used in monotherapy in 12 patients and combined with amikacin in three patients. At the end of therapy, a 93% rate of favorable clinical outcome was observed. Renal toxicity was encountered among 12 patients. It was severe in only two cases in which creatinine clearance decline surpassed 50% of the baseline value. No neurological toxicity was observed.. Colistin has an important role to play when used for the treatment of infections with multiresistant Gram-negative bacteria. Nephrotoxicity seems much lower than expected and neurotoxicity is minimal.

Topics: Abdominal Abscess; Anti-Bacterial Agents; Colistin; Gram-Negative Bacteria; Humans; Infusions, Intravenous; Kidney; Osteomyelitis; Pseudomonas aeruginosa; Pseudomonas Infections; Pyelonephritis; Retrospective Studies; Urinary Tract Infections