CASE STUDY

ISOLATION OF CARBAPENEM-RESISTANT AND COLISTIN-RESISTANT KLEBSIELLA PNEUMONIAE IN A UNIVERSITY HOSPITAL IN CASCAVEL, PARANÁ

Abstract

Introduction: Klebsiella pneumoniae is a member of Enterobacterales order associated with hospital-acquired infections due to its capability to express resistance mechanisms to various classes of antimicrobials.  Objective: To report a case of colonization by carbapenem-resistant and colistin-resistant Klebsiella pneumoniae (CRColR-KP), two of the main classes of antimicrobials used in multidrug-resistant (MDR) bacteria. Materials and Methods: The case data as well as laboratory test results were obtained through a search in the Electronic Patient Record (Tasy®), with analyses performed at the Clinical Analysis Laboratory of the University Hospital of Western Paraná and at the Central Laboratory of the State of Paraná. Results: The patient was admitted with a febrile peak and suspected sepsis. The infectious condition rapidly deteriorated, leading to the patient's death. During hospitalization, samples revealed an Escherichia coli infection and colonization by CRColR-KP MDR and mcr-1 negative. Discussion: The appearance of the first CRColR-KP mcr-1 negative case is concerning, because the lack of knowledge about the gene responsible for conferring such a characteristic makes it impossible to identify the mechanism, as well as to predict its dissemination to other gram-negative bacteria of interest. The search for an appropriate antibiotic therapy regimen for such cases is necessary. Conclusion: The appearance of the first colonization case by CRColR-KP MDR draws attention for its resistance profile and its gene expression. This case displays the difficulty to monitor and detect the spread antimicrobial resistance in MDR bacteria reported in the institution.