colistin and Leukemia--Monocytic--Acute

Emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) strains that also exhibit resistance to tigecycline and colistin have become a major clinical concern, as these two agents are the last-resort antibiotics used for treatment of CRKP infections. A leukemia patient infected with CRKP was subjected to follow-up analysis of variation in phenotypic and genotypic characteristics of CRKP strains isolated from various specimens at different stages of treatment over a period of 3 years. Our data showed that (1) carbapenem treatment led to the emergence of CRKP in the gastrointestinal (GI) tract of the patient, which subsequently caused infections at other body sites as well as septicemia; (2) treatment with tigecycline led to the emergence of tigecycline-resistant CRKP, possibly through induction of the expression of a variant tet(A) gene located in a conjugative plasmid; (3) colistin treatment was effective in clearing CRKP from the bloodstream but led to the emergence of mcr-1-positive Enterobacteriaceae strains as well as colistin-resistant CRKP in the GI tract due to inactivation of the mgrB gene; and (4) tigecycline- and colistin-resistant CRKP could persist in the human GI tract for a prolonged period even without antibiotic selection pressure. In conclusion, clinical CRKP strains carrying a conjugative plasmid that harbors the bla

Topics: Adult; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Carbapenems; Caspofungin; Colistin; Diarrhea; Drug Resistance, Bacterial; Echinocandins; Feces; Gastrointestinal Tract; Humans; Klebsiella Infections; Klebsiella pneumoniae; Leukemia, Monocytic, Acute; Lipopeptides; Male; Microbial Sensitivity Tests; Minocycline; Tigecycline; Treatment Outcome

Faecal volatile fatty acids represent the end products of the metabolism of the anaerobic flora of the large bowel. The excretion of these volatile acids has been investigated in five leukaemic patients maintained in plastic ;germ-free' isolators. Under ;isolator' conditions there is a pronounced fall in volatile fatty acid excretion. The possibility that the measurement of these acids may be used to monitor anaerobic overgrowth and recolonization in these patients is discussed.

Topics: Adult; Chromatography, Gas; Colistin; Fatty Acids, Volatile; Feces; Female; Gentamicins; Humans; Intestine, Large; Leukemia, Monocytic, Acute; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Male; Middle Aged; Nystatin; Patient Isolators; Propionates; Vancomycin