Department of Surgery, Weill Cornell Medical College, New York, New York 10065, USA.
Surg Infect (Larchmt). 2011 Aug;12(4):325-7. doi: 10.1089/sur.2010.072.
Gram-negative bacterial resistance to antibiotics is of increasing concern. Carbapenem resistance among strains of Klebsiella pneumoniae is a relatively new phenomenon. Resistance attributable to production of carbapenemases is notoriously difficult to combat.
Case report and review of the pertinent English-language literature.
A patient, hospitalized for aortic dissection complicated by intra-abdominal catastrophe and acute kidney injury, developed bacteremia exhibiting meropenem non-susceptibility secondary to expression of bla(KPC-2). High-dose, continuous-infusion meropenem achieved serum drug concentrations above the minimum inhibitory concentration and eradicated the infection.
This is the first report of a meropenem-non-susceptible carbapenamase-positive Klebsiella pneumoniae blood stream infection treated successfully with high-dose, continuous-infusion meropenem. Application of this regimen in certain patients, such as those with mild-to-moderate renal insufficiency, may be a reasonable option for multi-drug-resistant nosocomial infections.
革兰氏阴性菌对抗生素的耐药性日益受到关注。肺炎克雷伯菌菌株对碳青霉烯类抗生素的耐药性是一种相对较新的现象。由碳青霉烯酶的产生引起的耐药性极难治疗。
病例报告及相关英文文献复习。
一名因主动脉夹层合并腹腔灾难和急性肾损伤住院的患者发生了菌血症，其对美罗培南的药敏试验表现为中介，原因是 bla(KPC-2) 的表达导致碳青霉烯酶的产生。高剂量、持续输注美罗培能使血清药物浓度高于最低抑菌浓度，并根除感染。
这是首例碳青霉烯酶阳性肺炎克雷伯菌血流感染成功治疗的报告，该患者使用了高剂量、持续输注美罗培能。对于某些患者，如轻度至中度肾功能不全的患者，应用这种方案可能是治疗多药耐药性医院获得性感染的合理选择。
