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Penelope Evagelopoulou, Pavlos Myrianthefs, Antonios Markogiannakis, George Baltopoulos, Athanassios Tsakris, Multidrug-Resistant Klebsiella pneumoniae Mediastinitis Safely and Effectively Treated with Prolonged Administration of Tigecycline, Clinical Infectious Diseases, Volume 46, Issue 12, 15 June 2008, Pages 1932–1933, https://doi.org/10.1086/588557
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Tothe Editor—A recent article in Clinical Infectious Diseases reported the clinical and microbiological outcomes of 18 multidrug-resistant (MDR) gram-negative infections treated with tigecycline [1]. We report our experience with a case of mediastinitis caused by an MDR metallo-β-lactamase–producing Klebsiella pneumoniae that was treated with prolonged administration of tigecycline.
A 55-year-old morbidly obese and diabetic man was transferred to our intensive care unit after receiving a diagnosis of postsurgical mediastinitis after 3-vessel coronary artery bypass grafting. Cultures of adipose tissue samples and 4 different sternum samples (manubrium, body, xiphoid, and sternum bone marrow) yielded a K. pneumoniae isolate in pure and heavy growth. The organism exhibited an MDR phenotype; it was resistant to all aminoglycosides, fluoroquinolones, and β-lactams (including carbapenems) and to trimethoprim-sulfamethoxazole, but it remained susceptible to colistin, tetracycline, and tigecycline. The MIC of tigecycline was 0.5 µg/mL by both Etesting (AB Biodsik) and the standard agar dilution method. Molecular testing revealed that the isolate produced the blaVIM-1 metallo-β-lactamase gene in a class 1 integron. Colistin was not used because of mild renal function impairment, and tigecycline therapy became mandatory. A loading dose of 100 mg was given intravenously, followed by 50 mg given intravenously 2 times per day. After 1 week of tigecycline therapy in addition to intensive daily wound care and vacuum-assisted drainage [2], sternum culture results were still positive, and the patient had generalized edema (anasarka) and a marked decrease of myocardial function (ejection fraction, <30%).
