A case of fatal disseminated infection with masticator space abscess caused by ESBL-producing K57-ST412 hypervirulent Klebsiella pneumoniae.

A 70-year-old Japanese man with well-controlled diabetes mellitus and chronic kidney disease was hospitalized for an examination of acute renal failure and elevated inflammatory reactions. He had a history of Klebsiella pneumoniae bacteremia without extended-spectrum β-lactamase (ESBL) production five months earlier. The patient was found to have bacteremia due to hypermucoviscous ESBL-producing Klebsiella pneumoniae, and developed septic shock, multiple cerebral infarctions, and an abscess in the left masticatory muscle space. The causative organism was resistant to ampicillin-sulbactam and piperacillin-tazobactam, which were used for empiric therapy, and the patient died despite subsequent definitive treatment with meropenem. Whole genome sequencing analysis showed that the strain of K. pneumoniae was ST412 with capsular genotype K57 and carried virulence genes iroBCDN, iucABCD, iutA, mrkABCDFHIJ, rmpA2, ybtAEPQSTUX. The strain also carried the bla ESBL gene. Although the antimicrobial susceptibility of the causative organisms of hvKp infections in Japan has been favorable in most cases, severe infections caused by ESBL-producing hvKp may increase in the near future considering the recent increase in ESBL-producing K. pneumoniae.