International Journal of Infection

Published by: Kowsar

Sequential Emergence of Resistance to Multiple Antimicrobial Agents in KPC-Producing-Klebsiella pneumoniae

Marcela Nastro 1 , * , Carlos Hernan Rodriguez 1 , Claudia Barberis 1 , Carlos Vay 1 and Angela Famiglietti 1
Authors Information
1 Department of Clinical Biochemistry, Bacteriology Laboratory, Hospital de Clinicas Jose de San Martin, School of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina
Article information
  • International Journal of Infection: July 30, 2014, 1 (2); e18673
  • Published Online: July 20, 2014
  • Article Type: Case Report
  • Received: March 2, 2014
  • Revised: May 10, 2014
  • Accepted: May 17, 2014
  • DOI: 10.17795/iji-18673

To Cite: Nastro M, Rodriguez C H, Barberis C, Vay C, Famiglietti A. Sequential Emergence of Resistance to Multiple Antimicrobial Agents in KPC-Producing-Klebsiella pneumoniae, Int J Infect. 2014 ; 1(2):e18673. doi: 10.17795/iji-18673.

Copyright © 2014, Infectious Diseases and Tropical Medicine Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Introduction
2. Case Presentation
3. Discussion
  • 1. Cejas D, Fernandez Canigia L, Nastro M, Rodriguez C, Tanco A, Rodriguez H, et al. Hyperendemic clone of KPC producing Klebsiellapneumoniae ST 258 in Buenos Aires hospitals. Infect Genet Evol. 2012; 12(3): 499-501[DOI][PubMed]
  • 2. Wayne D. Clinical and Laboratory Standards Institute(CLSI) document M100-S21 Performance Standards for Antimicrobial Susceptibility Testing 21st Informational Supplement. 2011;
  • 3. Breakpoint tables for interpretation of MICs and zone diameters Version 1.0. 2009;
  • 4. Members of the SFMAC. Comite de l'Antibiogramme de la Societe Francaise de Microbiologie report 2003. Int J Antimicrob Agents. 2003; 21(4): 364-91[PubMed]
  • 5. Bradford PA. Tigecycline: a first in class glycylcycline. Clin Microbiol Newsl. 2004; 26(21): 163-8[DOI]
  • 6. Bradford PA, Bratu S, Urban C, Visalli M, Mariano N, Landman D, et al. Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 beta-lactamases in New York City. Clin Infect Dis. 2004; 39(1): 55-60[DOI][PubMed]
  • 7. Limansky AS, Viale AM. Can composition and structural features of oligonucleotides contribute to their wide-scale applicability as random PCR primers in mapping bacterial genome diversity? J Microbiol Methods. 2002; 50(3): 291-7[PubMed]
  • 8. Rodriguez CH, De Ambrosio A, Bajuk M, Spinozzi M, Nastro M, Bombicino K, et al. In vitro antimicrobials activity against endemic Acinetobacter baumannii multiresistant clones. J Infect Dev Ctries. 2010; 4(3): 164-7[PubMed]
  • 9. Poudyal A, Howden BP, Bell JM, Gao W, Owen RJ, Turnidge JD, et al. In vitro pharmacodynamics of colistin against multidrug-resistant Klebsiella pneumoniae. J Antimicrob Chemother. 2008; 62(6): 1311-8[DOI][PubMed]
  • 10. Levy Hara G, Gould I, Endimiani A, Pardo PR, Daikos G, Hsueh PR, et al. Detection, treatment, and prevention of carbapenemase-producing Enterobacteriaceae: recommendations from an International Working Group. J Chemother. 2013; 25(3): 129-40[DOI][PubMed]
  • 11. Rahal JJ. Novel antibiotic combinations against infections with almost completely resistant Pseudomonas aeruginosa and Acinetobacter species. Clin Infect Dis. 2006; 43 Suppl 2-9[DOI][PubMed]
  • 12. Urban C, Mariano N, Rahal JJ. In vitro double and triple bactericidal activities of doripenem, polymyxin B, and rifampin against multidrug-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli. Antimicrob Agents Chemother. 2010; 54(6): 2732-4[DOI][PubMed]
  • 13. Meletis G, Tzampaz E, Sianou E, Tzavaras I, Sofianou D. Colistin heteroresistance in carbapenemase-producing Klebsiella pneumoniae. J Antimicrob Chemother. 2011; 66(4): 946-7[DOI][PubMed]
  • 14. Spanu T, De Angelis G, Cipriani M, Pedruzzi B, D'Inzeo T, Cataldo MA, et al. In vivo emergence of tigecycline resistance in multidrug-resistant Klebsiella pneumoniae and Escherichia coli. Antimicrob Agents Chemother. 2012; 56(8): 4516-8[DOI][PubMed]
  • 15. Rodriguez-Avial C, Rodriguez-Avial I, Merino P, Picazo JJ. Klebsiella pneumoniae: development of a mixed population of carbapenem and tigecycline resistance during antimicrobial therapy in a kidney transplant patient. Clin Microbiol Infect. 2012; 18(1): 61-6[DOI][PubMed]
  • 16. Ruzin A, Visalli MA, Keeney D, Bradford PA. Influence of transcriptional activator RamA on expression of multidrug efflux pump AcrAB and tigecycline susceptibility in Klebsiella pneumoniae. Antimicrob Agents Chemother. 2005; 49(3): 1017-22[DOI][PubMed]
  • 17. Pournaras S, Vrioni G, Neou E, Dendrinos J, Dimitroulia E, Poulou A, et al. Activity of tigecycline alone and in combination with colistin and meropenem against Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae strains by time-kill assay. Int J Antimicrob Agents. 2011; 37(3): 244-7[DOI][PubMed]
  • 18. Daikos GL, Markogiannakis A. Carbapenemase-producing Klebsiella pneumoniae: (when) might we still consider treating with carbapenems? Clin Microbiol Infect. 2011; 17(8): 1135-41[DOI][PubMed]
  • 19. Endimiani A, Patel G, Hujer KM, Swaminathan M, Perez F, Rice LB, et al. In vitro activity of fosfomycin against blaKPC-containing Klebsiella pneumoniae isolates, including those nonsusceptible to tigecycline and/or colistin. Antimicrob Agents Chemother. 2010; 54(1): 526-9[DOI][PubMed]
  • 20. Karageorgopoulos DE, Miriagou V, Tzouvelekis LS, Spyridopoulou K, Daikos GL. Emergence of resistance to fosfomycin used as adjunct therapy in KPC Klebsiella pneumoniae bacteraemia: report of three cases. J Antimicrob Chemother. 2012; 67(11): 2777-9[DOI][PubMed]
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments