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Case Reports
. 2015 Apr;16(2):188-93.
doi: 10.1089/sur.2012.175. Epub 2014 May 21.

Multi-drug-resistant Klebsiella pneumoniae pancreatitis: a new challenge in a serious surgical infection

Derin Tugal  1 , Melanie Lynch, Andrea M Hujer, Susan Rudin, Federico Perez, Robert A Bonomo
Affiliations
Case Reports

Multi-drug-resistant Klebsiella pneumoniae pancreatitis: a new challenge in a serious surgical infection

Derin Tugal et al. Surg Infect (Larchmt). 2015 Apr.

Abstract

Background: Klebsiella pneumoniae is an important cause of nosocomial infections, but its role in severe acute pancreatitis (SAP) is not well defined. Few cases of K. pneumoniae associated SAP have been reported. Due to the emergence of extended-spectrum beta-lactamases (ESBLs) and carbapenemases, treatment of multidrug-resistant (MDR) K. pneumoniae presents a challenge. Tigecycline and colistin have gained recent attention for their broad-spectrum antimicrobial activity.

Methods: We describe a case of SAP due to K. pneumoniae bearing K. pneumoniae carbapenemase (KPC) treated successfully with colistin plus tigecycline and offer a review of similar experiences published in the literature.

Results: The case reported herein required surgical drainage of multiple pancreatic abscesses and treatment with tigecycline and colistin. Our comparative analysis revealed a number of unique features associated with SAP due to K. pneumoniae: 1) underlying pancreatic injury, 2) multiple drug resistance determinants and virulence factors that complicate treatment, and 3) surgical debridement as a requirement for cure.

Conclusion: As the prevalence of K. pneumoniae bearing KPC continues to increase in the healthcare setting, SAP caused by this MDR pathogen will become more common. Tigecycline plus colistin was a successful antibiotic regimen for the treatment of SAP due to K. pneumoniae bearing KPC.

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Figures

<b>FIG. 1.</b>
FIG. 1.
(A) Computed tomography of abdomen on day 50 after presentation showing a large cystic lesion replacing most of the pancreas and measuring approximately 19×10 cm in diameter. (B) Computed tomography of abdomen obtained on day 69 revealing fluid collection with presence of gas bubbles, suggesting infection.
<b>FIG. 2.</b>
FIG. 2.
Necrotic pancreas removed surgically from our patient on day 70. Color images available online at www.liebertpub.com/sur
See this image and copyright information in PMC

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