colistin and Aortic-Aneurysm--Abdominal

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.

Topics: Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortography; Bacterial Proteins; beta-Lactamases; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Carbapenems; Colistin; Computed Tomography Angiography; Device Removal; Drug Resistance, Bacterial; Endovascular Procedures; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Prosthesis-Related Infections; Treatment Outcome