Meropenem Combined with Ertapenem Rescues a Patient with Multi-Drug Resistant Klebsiella pneumoniae V113 Isolate Infection and Acute-on-Chronic Liver Failure: A Case Report

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Lu Jianchun; Xu Tianmin; Chen Chunhua; Zheng Shuqin; Lin Lin; Xue Yuan

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Journal: Hepatitis Monthly Year:2020 | Volume:20 | Issue:3 Page(s): 0-0

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Title

Meropenem Combined with Ertapenem Rescues a Patient with Multi-Drug Resistant Klebsiella pneumoniae V113 Isolate Infection and Acute-on-Chronic Liver Failure: A Case Report

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Keywords

Carbapenemase

Meropenem

Ertapenem

Acute-on-Chronic Liver Failure

Klebsiella pneumoniae

Abstract

Introduction: Severe infection is a major risk factor for mortality in patients with liver failure. Multidrug-resistant Klebsiella pneumoniae may lead to fatal infection, especially in patients with severe hepatitis. Case Presentation: We describe a 70-year-old Chinese patient with Acute-on-Chronic Liver Failure (ACLF) and multidrug-resistant KPC-producing K. peumoniae V113 isolate infection. The serum total bilirubin (TBIL) level was 308. 7 mol/L at the time of admission, and the international normalized ratio (INR) was 2. 56. The serum level of TBIL ascended to 526 mol/L on the 14th day after admission, and then gradually declined. The INR was maintained above 1. 5 for 2 months. Creatinine level significantly increased (from 92. 5 to 241 mol/L) in the first month after admission, while estimated glomerular filtration rate declined to 16. 9 mL/min 1. 73m2. Diammonium glycyrrhizinate, plasma, as well as albumin were given intravenously. At the time of admission, she had sepsis with symptoms, including fever and shivering, and K. pneumoniae was identified by blood culture test. Biapenem combined with moxifloxacin was shown to be effective, while that could not eliminate the bacteria. Fever and shivering re-occurred, and repeated drug susceptibility tests confirmed the same multidrug-resistant K. pneumoniae isolate without extended-spectrum -lactamases. Combination treatment of Meropenem and Ertapenem resulted in a positive clinical outcome without deterioration of liver function. Furthermore, single-molecule real-time (SMRT) sequencing identified 3 genes (blaPKC, blaTXM, and catA2) on the plasmid and 3 genes (blaSHV2, catB3, and arnA) on the chromosome. Moreover, 10 multidrug resistanceeffluxpumpgenes and 2 fosmidomycineffluxpump genes were found on the chromosome. Conclusions: Meropenem combined with Ertapenem might be used for treating patients with ACLF and multi-drug resistant K. pneumoniae V113 isolate infection.

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APA: Copy

Lu, Jianchun, Xu, Tianmin, Chen, Chunhua, Zheng, Shuqin, Lin, Lin, & Xue, Yuan. (2020). Meropenem Combined with Ertapenem Rescues a Patient with Multi-Drug Resistant Klebsiella pneumoniae V113 Isolate Infection and Acute-on-Chronic Liver Failure: A Case Report. HEPATITIS MONTHLY, 20(3), 0-0. SID. https://sid.ir/paper/758720/en

Vancouver: Copy

Lu Jianchun, Xu Tianmin, Chen Chunhua, Zheng Shuqin, Lin Lin, Xue Yuan. Meropenem Combined with Ertapenem Rescues a Patient with Multi-Drug Resistant Klebsiella pneumoniae V113 Isolate Infection and Acute-on-Chronic Liver Failure: A Case Report. HEPATITIS MONTHLY[Internet]. 2020;20(3):0-0. Available from: https://sid.ir/paper/758720/en

IEEE: Copy

Jianchun Lu, Tianmin Xu, Chunhua Chen, Shuqin Zheng, Lin Lin, and Yuan Xue, “Meropenem Combined with Ertapenem Rescues a Patient with Multi-Drug Resistant Klebsiella pneumoniae V113 Isolate Infection and Acute-on-Chronic Liver Failure: A Case Report,” HEPATITIS MONTHLY, vol. 20, no. 3, pp. 0–0, 2020, [Online]. Available: https://sid.ir/paper/758720/en

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