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Emergence of concurrent infections with colistin-resistant ESBL-positive Klebsiella pneumoniae and OXA-23-producing Acinetobacter baumannii sensitive to colistin only in a Romanian cardiac intensive care unit

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Abstract

We report the emergence and analysis of a cluster of concurrent infections/colonisations with colistin-resistant Klebsiella pneumoniae and OXA-23 carbapenemase-producing Acinetobacter baumannii in patients who had undergone cardiac surgery. We describe the emergence of colistin-resistant K. pneumoniae harbouring bla CTX-M-15, bla SHV-11, bla OXA-1, bla TEM-1 beta-lactamases and aac(6’)-Ib-cr fluoroquinolone resistance. Colistin-resistant K. pneumoniae infections (pneumonia, wound infection, urinary tract infections and bacteraemia) occurred in critically ill patients previously treated with colistin for post-surgery infections with carbapenem-resistant Pseudomonas aeruginosa and/or A. baumannii. Although the cause of death could not be directly attributed to a single pathogen, three patients co-infected/colonised with K. pneumoniae, P. aeruginosa and/or A. baumannii died, whilst a fourth patient who had a mono-microbial infection with colistin-resistant K. pneumoniae only survived. The use of mobile intubation equipment in patients that shared the same ward, the clustering of cases over a short period of time, as well as the pulsed-field gel electrophoresis (PFGE) data all suggest cross-contamination between patients, either through equipment or by staff contact transmission. This report presents the ‘worst-case scenario’ where concurrent infection/colonisation with pathogens exhibiting resistance to different types of last-resort antimicrobials occurred in some of the most debilitated intensive care unit (ICU) patients.

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Acknowledgement

This work was supported by a grant from the Society for General Microbiology (International Development Fund).

Conflict of interest

The authors declare that they have no conflict of interest.

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    Authors and Affiliations

    1. School of Veterinary Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, CH64 7TE, UK

      D. Timofte & I. E. Maciuca

    2. Institute of Cardiovascular Diseases, Iasi, Romania

      M. Dan, L. Ciucu, E. R. Dabija & C. V. Panzaru

    3. University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania

      C. V. Panzaru

    4. Faculty of Veterinary Medicine, University of Agronomical Sciences and Veterinary Medicine, Iasi, Romania

      D. Timofte, I. E. Maciuca & E. Guguianu

    5. Institute of Infection and Global Health, University of Liverpool, Liverpool, UK

      D. Timofte

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    1. D. Timofte
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    Correspondence to D. Timofte.

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    D. Timofte, M. Dan and I. E. Maciuca contributed equally to this work.

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    Timofte, D., Dan, M., Maciuca, I.E. et al. Emergence of concurrent infections with colistin-resistant ESBL-positive Klebsiella pneumoniae and OXA-23-producing Acinetobacter baumannii sensitive to colistin only in a Romanian cardiac intensive care unit. Eur J Clin Microbiol Infect Dis 34, 2069–2074 (2015). https://doi.org/10.1007/s10096-015-2453-3

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    • DOI: https://doi.org/10.1007/s10096-015-2453-3

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