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Kuei-Pin Chung, Sung-Pin Tseng, Yu-Tsung Huang, Tzu-Hsiu Tsai, Lee-Jene Teng, Po-Ren Hsueh, Arrival of Klebsiella pneumoniae carbapenemase (KPC)-2 in Taiwan, Journal of Antimicrobial Chemotherapy, Volume 66, Issue 5, May 2011, Pages 1182–1184, https://doi.org/10.1093/jac/dkr025
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Sir,
Carbapenem-resistant Gram-negative bacteria represent an emerging threat to the management of hospital-acquired infections.1 Recently, Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae strains have been reported worldwide.1 In China, KPC-producing Enterobacteriaceae strains are widely distributed nationwide, particularly in Zhejiang Province.2,3 This report confirms, to our knowledge for the first time, the arrival of KPC-2-producing K. pneumoniae in Taiwan.
A middle-aged man, who did business in Zhejiang Province in China, was admitted to the intensive care unit (ICU) in a hospital in Zhejiang after successful resuscitation for cardiac arrest due to an unknown cause in 2010. He developed a sustained fever, together with leucocytosis, thrombocytopenia and anaemia after resuscitation. Empirical antibiotic therapy with cefoperazone/sulbactam was given. Three days after admission he was transferred to the medical ICU at National Taiwan University Hospital (NTUH).
On admission to NTUH, the patient was in a deep coma and put on a ventilator. His body temperature was 38.2°C. Laboratory examinations revealed leucocytosis, anaemia, thrombocytopenia and abnormal renal and liver function. Chest radiography initially did not show a pneumonia patch on the first hospital day. Intermittent haemodialysis was performed for acute renal injury. Intravenous ceftriaxone (1 g every 12 h) was given empirically. However, fever persisted along with increased purulent sputum production. Chest radiography on the third hospital day showed consolidation in the right lower lobe. Ventilator-associated pneumonia was suspected and intravenous colistin (1.3 MU daily) was given empirically because the sputum culture obtained on the first hospital day yielded imipenem-resistant and colistin-susceptible Pseudomonas aeruginosa. The blood culture (isolate A) and sputum culture (isolate B) obtained on the third hospital day both grew imipenem-resistant K. pneumoniae. Cultures of an anal swab (isolate C) on the fifth hospital day also grew imipenem-resistant K. pneumoniae.
