PDF(Pubmed)
Abstract：
Carbapenem-resistant Enterobacterales (CRE) pose a significant public health concern. CRE could be carbapenamse producers or non-producers. In the Kingdom of Saudi Arabia, bla OXA-48 and bla NDM represent the majority of carbapenemase isolates. There are very limited treatment options for carbapenemase-producing CRE caused by bla NDM. Ceftazidime-avibactam plus aztreonam (CZA-ATM) or cefiderocol as monotherapy are considered the treatment of choice for these infections. Here, we report a case of a 70-year-old man presented with surgical site infection of above knee amputation stump. The cultures revealed carbapenem-resistant Klebsiella pneumoniae positive for bla NDM and bla OXA-48 resistant to CZA-ATM therapy and intermediate susceptibility to tigecycline. He was started on CZA-ATM both adjusted for renal function, and high dose tigecycline with daily wound dressing and irrigation. By day 20 of the antibiotic regimens, he had clinical and microbiological cure based on repeated wound cultures. This case identifies a rare incidence of CRE skin and soft tissue infection positive for bla NDM and bla OXA-48 resistant to CZA-ATM in a background of limited targeted options, but successfully treated with CZA-ATM and high-dose tigecycline. Such therapeutic approach might be useful in few circumstances when no other antibiotic options are available to treat extensively drug-resistant Klebsiella pneumoniae.
摘要：
耐碳青霉烯类肠杆菌（CRE）引起了重大的公共卫生问题。CRE可以是碳青霉烯糖生产者或非生产者。在沙特阿拉伯王国，blaOXA-48和blaNDM代表大多数碳青霉烯酶分离物。由blaNDM引起的产生碳青霉烯酶的CRE的治疗选择非常有限。头孢他啶-阿维巴坦加氨曲南（CZA-ATM）或头孢地洛作为单一疗法被认为是这些感染的首选治疗方法。这里,我们报告了一例70岁的男性患者，其手术部位感染了膝关节以上截肢残端。培养物显示，耐碳青霉烯类肺炎克雷伯菌对CZA-ATM疗法耐药的blaNDM和blaOXA-48呈阳性，对替加环素具有中等敏感性。他开始使用CZA-ATM进行肾功能调整，和高剂量替加环素，每日伤口敷料和冲洗。到抗生素治疗方案的第20天，他根据反复的伤口培养进行了临床和微生物治疗。在有限的靶向选择背景下，该病例确定了对CZA-ATM具有抗性的BlaNDM和BlaOXA-48阳性的CRE皮肤和软组织感染的罕见发生率。但用CZA-ATM和大剂量替加环素成功治疗。当没有其他抗生素选择可用于治疗广泛耐药的肺炎克雷伯菌时，这种治疗方法在少数情况下可能有用。
