Department of Sciences for Health Promotion G, D'Alessandro, University of Palermo, Via del Vespro 133, Palermo, I-90127, Italy.
BMC Gastroenterol. 2011 Sep 30;11:103. doi: 10.1186/1471-230X-11-103.
Knowledge of the etiology of pyogenic liver and pancreatic abscesses is an important factor in determining the success of combined surgical and antibiotic treatment. Literature shows geographical variations in the prevalence and distribution of causative organisms, and the spread of Klebsiella pneumoniae carbapenemase-producing bacteria is an emerging cause of abdominal infections.
We herein describe two cases of intra-abdominal abscesses due to monomicrobial infection by Klebsiella pneumoniae Sequence Type 258 producing K. pneumoniae carbapenemase 3 (KPC-Kp). In case 1, a 50-year-old HIV-negative Italian woman with chronic pancreatitis showed infection of a pancreatic pseudocystic lesion caused by KPC-Kp. In case 2, a 64-year-old HIV-negative Italian woman with pancreatic neoplasm and liver metastases developed a liver abscess due to KPC after surgery. Both women were admitted to our hospital but to different surgical units. The clonal relationship between the two isolates was investigated by pulsed-field gel electrophoresis (PFGE). In case 2, the patient was already colonized at admission and inter-hospital transmission of the pathogen was presumed. A long-term combination regimen of colistin with tigecycline and percutaneous drainage resulted in full recovery and clearance of the multidrug-resistant (MDR) pathogen.
Timely microbiological diagnosis, the combined use of new and old antibiotics and radiological intervention appeared to be valuable in managing these serious conditions. The emergence and dissemination of MDR organisms is posing an increasing challenge for physicians to develop new therapeutic strategies and control and prevention frameworks.
了解化脓性肝和胰腺脓肿的病因是决定联合手术和抗生素治疗成功的重要因素。文献表明，致病微生物的流行和分布存在地域差异，而产碳青霉烯酶肺炎克雷伯菌的传播是腹部感染的一个新出现的原因。
我们在此描述两例由产碳青霉烯酶肺炎克雷伯菌 3（KPC-Kp）的单一致病菌引起的腹腔脓肿。在病例 1 中，一名 50 岁的 HIV 阴性意大利女性患有慢性胰腺炎，其胰腺假性囊肿病变感染了 KPC-Kp。在病例 2 中，一名 64 岁的 HIV 阴性意大利女性患有胰腺肿瘤和肝转移，手术后发生了 KPC 引起的肝脓肿。两名女性均被收入我院，但入住不同的外科病房。通过脉冲场凝胶电泳（PFGE）研究了两种分离株之间的克隆关系。在病例 2 中，患者入院时已被定植，且假定病原体在医院间传播。长期联合使用多粘菌素和替加环素以及经皮引流治疗，使患者完全康复，清除了这种多重耐药（MDR）病原体。
及时的微生物学诊断、新老抗生素的联合使用以及影像学介入似乎对治疗这些严重情况具有重要价值。MDR 病原体的出现和传播对医生制定新的治疗策略、控制和预防框架提出了越来越大的挑战。
