关键词: Carbapenem-resistant Cardiac transplantation Donor-derived infection Klebsiella pneumoniae

Mesh : Anti-Bacterial Agents / pharmacology Carbapenem-Resistant Enterobacteriaceae / isolation & purification Colistin / pharmacology Drug Resistance, Multiple, Bacterial Fatal Outcome Heart Transplantation / adverse effects Humans Klebsiella Infections / drug therapy transmission Klebsiella pneumoniae / isolation & purification Male Middle Aged Risk Factors Tissue Donors Transplant Recipients

来  源:   DOI:10.1016/j.bjid.2018.04.005

Abstract:
Herein we report a fatal case of donor-derived transmission of XDR-resistant carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) in cardiac transplantation. A 59-year-old male patient with non-obstructive hypertrophic cardiomyopathy underwent heart transplantation. On day 5 post-operation, blood cultures from the donor were positive for colistin-resistant carbapenemase-producing K. pneumoniae (ColR KPC-Kp) susceptible only to amikacin. Recipient blood cultures were also positive for ColR KPC-Kp with the same sensitivity profile as the donor isolate with an identical PFGE pattern. The patient was treated with double-carbapenems and amikacin. The patient evolved to pericarditis, osteomyelitis, and pulmonary necrosis, all fragment cultures positive for the same agent. The patient developed septic shock, multiple organ failure and died on day 50 post-transplantation. Based on current microbiological scenario worldwide the possibility of transmitting multidrug resistant (MDR) organisms should be considered.
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