The first case of revealing of Klebsiella pneumoniae ST147, producing NDM-1 carbapenemase, in trauma and orthopedic hospital in Russia

Cover Page

Abstract

Present report describes the first case of isolation of NDM-1 carbapenemase-producing K. pneumoniae in a patient with wound infection after open tibial fracture. Identical isolates were twice detected in various microbial associations: first time during therapy with ampicillin/sulbactam, second time after the relapse of wound infection during therapy with cephoperazone/sulbactam with vancomycin. The strain of K. pneumoniae was resistant to all beta-lactams, aminoglycosides and fluoroquinolones, but retained susceptibility to tigecycline and polymyxin B. The presence of blaNDM-1 was detected by PCR and Sanger sequencing. On the basis of multilocus sequence typing K. pneumoniae isolate was classified as sequence-type 147 (ST147). Eradication of the pathogen, successful osteosynthesis of tibial bones and skin-muscle flap plasty of the extensive wound were completed together with combined dioxydin and phosphomycin therapy. Due to the danger of the emergence of nosocomial infection sources and of the development of the potentially incurable nosocomial implant-associated infection, detection of NDM-1 carbapenemase-producing K. pneumoniae strain in a trauma and orthopedic in-patient clinic is alarming.

About the authors

V. V. Shabanova

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: tichvin@yandex.ru
Russian Federation

M. V. Krasnova

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

S. A. Bozhkova

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

V. A. Ageevets

Scientific Research Institute of Children’s Infections

Email: noemail@neicon.ru
Russian Federation

I. V. Lazareva

Scientific Research Institute of Children’s Infections

Email: noemail@neicon.ru
Russian Federation

A. N. Rukina

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

S. V. Sidorenko

Scientific Research Institute of Children’s Infections; Mechnikov North-Western State Medical University

Email: noemail@neicon.ru
Russian Federation

References

  1. Агеевец В.А., Партина И.В., Лисицына Е.С., Батыршин И.М., Попенко Л.Н., Шляпников С.А., Ильина Е.Н., Сидоренко С.В. Первое обнаружение металло-бета- лактамазы ndm-типа в многопрофильном стационаре в России. Медицинский академический журнал. 2012; (4):43-45.
  2. Божкова С.А., Тихилов Р.М., Краснова М.В., Рукина А.Н. Ортопедическая имплантат-ассоциированная инфекция: ведущие возбудители, локальная резистентность и рекомендации по антибактериальной терапии. Травматология и ортопедия России. 2013; 4(70):5-15.
  3. Гординская Н.А., Сабирова Е.В., Абрамова Н.В., Дударева Е.В., Митрофанов В.Н. Резистентность основных возбудителей инфекции в отделении гнойной остеологии. Вопросы травматологии и ортопедии. 2012; 1(2):14-17.
  4. Егорова С.А., Кафтырева Л.А., Липская Л.В., Коноваленко И.Б., Пясетская М.Ф., Курчикова Т.С., Ведерникова Н.Б., Морозова О.Т., Смирнова М.В., Попенко Л.Н., Любушкина М.И., Савочкина Ю.А., Макарова М.А., Сужаева Л.В., Останкова Ю.В., Иванова М.Н., Павелкович А.М., Наабер П., Сепп Э., Кыльялг С., Мицюлявичене И., Балоде А. Штаммы энтеробактерий, продуцирующие бета-лактамазы расширенного спектра и металло-р-лактамазу ndm-1, выделенные в стационарах в странах балтийского региона. Инфекция и иммунитет. 2013; 1(3):29-36.
  5. Розова Л.В., Годовых Н.В. Сравнительная характеристика видового состава микроорганизмов при хроническом посттравматическом и гематогенном остеомиелите. Гений Ортопедии. 2014; (2):56-59.
  6. Ageevets V.A., Partina I.V., Lisitsyna E.S., Ilina E.N., Lobzin Y.V., Shlyapnikov S., Sidorenko S.V. Emergence of carbapenemase-producing Gram-negative bacteria in Saint Petersburg, Russia. Int J Antimicrob Agents. 2014; 44(2):152-155.
  7. Bessa J.L., Fazii P., Di Giulio M., Cellini L. Bacterial isolates from infected wounds and their antibiotic susceptibility pattern: some remarks about wound infection. Int Wound J. 2015; 12(1): 47-52.
  8. Cardoso O., Leitao R., Figueiredo A., Sousa J.C., Duarte A., Peixe L.V. Metallo-beta-lactamase VIM-2 in clinical isolates of Pseudomonas aeruginosa from Portugal. Microbial Drug Resistance. 2002; 8:93-97.
  9. De Sanctis J., Teixeira L., van Duin D., Odio C., Hall G., Tomford J.W., Perez F, Rudin S. D., Schmitt S. Complex prosthetic joint infections due to carbapenemase- producing Klebsiella pneumoniae: А unique challenge in the era of untreatable infections. Int J Infect Dise. 2014; 25:73-78.
  10. EUCAST Breakpoint tables for interpretation of MICs and zone diameters. Breakpoint tables for interpretation of MICs and zone diameters. Version 2.0. 2012:1-73. Available: http://www.eucast.org/ clinical_breakpoints/
  11. EUCAST Breakpoint tables for interpretation of MICs and zone diameters. Breakpoint tables for interpretation of MICs and zone diameters. Version 3.0. 2013:1-76. Available: http://www.eucast.org/clinical_breakpoints/
  12. Gupta V., Bansal N., Gupta R., Chander J. Klebsiella pneumoniae carrying bla NDM-1 gene in orthopedic practice. Ind J Orthop. 2014; 48(5): 533-535.
  13. Johnson A.P., Woodford N. Global spread of antibiotic resistance: the example of New Delhi metallo-beta- lactamase (NDM)-mediated carbapenem resistance. J Med Microbiol. 2013; 62:499-513.
  14. Partina I., Ageevets V., Goncharov A., Zueva L., Sidorenko S. Cross-sectional study of fecal carriage of carbapenem resistant Gram-negative bacteria in Saint Petersburg hospitals. 25th European Congress of Clinical Microbiology and Infectious Diseases, At Copenhagen, Denmark. 2015. Режим доступа: https://www.escmid.org/escmid_ library/online_lecture_library/?search=1¤t_ page=1&search_term=partina
  15. Poirel L., Naas T., Nicolas D., Collet L., Bellais S., Cavallo J.D., Nordmann P. Characterization of VIM-2, a carbapenem-hydrolyzing metallo-beta-lactamase and its plasmid- and integron-borne gene from a Pseudomonas aeruginosa clinical isolate in France. Antimicrob Agents Chemother. 2000; 44:891-897.
  16. Walsh T.R., Toleman M.A., Poirel L., Nordmann P. Metallo- beta-lactamases: the quiet before the storm? Clin Microbiol Rev. 2005; 18:306-325.
  17. Watanabe M., Iyobe S., Inoue M., Mitsuhashi S. Transferable imipenem resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1991; 35:147-151.
  18. Yong D., Toleman M.A., Giske C.G., Cho H.S., Sundman K., Lee K., Walsh T.R. Characterization of a new metallo-beta-lactamase gene, bla (NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother. 2009; 53(12): 5046-5054.

Statistics

Views

Abstract: 311

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c) 2015



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies