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Open Access Case report

Two cases of monomicrobial intraabdominal abscesses due to KPC - 3 Klebsiella pneumoniae ST258 clone

Paola Di Carlo1*, Gianni Pantuso2, Alessia Cusimano2, Francesco D'Arpa3, Anna Giammanco1, Gaspare Gulotta3, Adelfio M Latteri2, Simona Madonia1, Giuseppe Salamone3 and Caterina Mammina1

Author Affiliations

1 Department of Sciences for Health Promotion "G. D'Alessandro", University of Palermo, Via del Vespro 133, Palermo, I-90127, Italy

2 Department of Surgery and Oncology, University of Palermo, Via del Vespro 133, Palermo, I-90127, Italy

3 Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via del Vespro 133, Palermo, I-90127, Italy

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BMC Gastroenterology 2011, 11:103  doi:10.1186/1471-230X-11-103

Published: 30 September 2011

Abstract

Background

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.

Case presentation

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.

Conclusions

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.

Keywords:
monomicrobial abscess; Klebsiellae pneumoniae; carbapenemases