Prolonged febrile illness due to CTX-M-15 extended-spectrum β-lactamase-producing Klebsiella pneumoniae infection in Nigeria

Abstract

We report on an 8-year-old patient with septicaemia unresponsive to therapy for five weeks. Undetected, extended-spectrum β-lactamase (ESBL) production by the infecting Klebsiella strain was regarded as responsible for treatment failure. Intravenously administered imipenem during the sixth week led to sustained resolution of fever. Resource-limited hospitals can incur prohibitive costs from ESBL-producer infections because of diagnostic limitations and consequent treatment failure involving prolonged supportive therapy.

FIGURE 1

PCR amplification of the variable regions of class 1 and class 2 integrons. (a) Class 1 integron-variable regions amplified using Lev5’CS and Lev3’CS primers. Lane 1: No template; Lane 2: E. coli strain 042 bearing an aadA cassette within a class 1 integron; Lane 3: E. coli strain 17-2 bearing the dfrA1-sat-aadA cassette sequence within a class 2 integron; Lane 4: K. pneumoniae subsp. pneumoniae isolate K01 from this study; Lane 5: 1 kb Ladder plus (Invitrogen). Marker size fragments are indicated to the right of the gel in kilobase pairs. (b) Class 2 integron-variable regions amplified using hep51 and hep74 primers with samples shown in (a) loaded on to the gel. (c) Cassette content and orientation of the K01 integron amplified in (A), as predicted from the DNA sequence.

FIGURE 2

PCR amplification of a ctx allele from K. pneumoniae subsp. pneumoniae isolate K01 from this study. Lane 1: 1 kb Ladder plus (Invitrogen). Lane 2: K01. Lane 3: ESBL-negative E. coli strain 042. Lane 4: No template. Marker size fragments are indicated to the left of the gel in Kilobase pairs. In the absence of a positive control, the identity of the band amplified from strain K01 was determined by sequencing.