Klebsiella pneumoniae: a case report of pneumonia and cephalosporins resistant clinical isolate

Abstract

Background: Klebsiella pneumoniae (K. pneumoniae) is a Gram-negative bacterium that causes respiratory, urinary tract and blood stream infections associated with community and nosocomial infections with serious health implications.

Objective: The study aimed to determine the management response of the patient, from the empirical stage until discharge. Also to identify the aetiology and evaluate antimicrobial susceptibility profile of the isolate.

Case management and methods: A case of a 55-year-old-male patient with pneumonia-like symptoms, who presented to Sheikh Muhammad Jidda Specialist Hospital, Kano, Nigeria. The patient was empirically administered with ceftazidime antibiotic, resulting in mild irritation as a symptom of side effects, with no positive response from the patient. Later, the treatment was reviewed to maxipime (1g/50 mL) infusion, which was parenterally administered twice daily for 10 days. The symptoms completely resolved, and the patient fully recovered and was discharged on day 15. Routine and specific bacteriological investigations were conducted to establish the aetiology. A positive string test was conducted on the isolate for the detection of hypermucoviscosity. A polymerase chain reaction (PCR) assay was performed to detect the rmpA gene associated with hypermucoviscosity that causes hypervirulence.

Results: Results showed that K. pneumoniae was the causative agent with resistance to generations of cephalosporins (second and third). The therapy was successful using maxipime, a fourth-generation cephalosporin (cefepime). The findings indicated that the isolate is multidrug-resistant. The formation of a viscous filament ≥5 mm, confirmed the hypermucoviscosity of the isolate. PCR gel electrophoresis results of the amplified rmpA gene showed ~600 bp band size and was confirmed by DNA sequencing.

Conclusion: The use of maxipime as antibiotic therapy for the treatment of the patient with pneumonia infection was successful. The isolate was resistant to second and third-generation cephalosporins. It is important to achieve accurate and prompt identification of such resistant and virulent strains to avoid community-based spread.