Emergence of ceftazidime-avibactam-resistant Klebsiella pneumoniae during treatment, Finland, December 2018

Euro Surveill. 2019 May;24(19):1900256. doi: 10.2807/1560-7917.ES.2019.24.19.1900256.

Abstract

In December 2018, a ceftazidime-avibactam (CAZ-AVI)-resistant KPC-2-producing Klebsiella pneumoniae strain was isolated in Finland. CAZ-AVI resistance was observed 34 days after CAZ-AVI treatment in a trauma patient transferred from a hospital in Greece who had been colonised with blaKPC-2-producing K. pneumoniae ST39, and later developed a bloodstream infection. The CAZ-AVI-resistant strain contained a novel 15 amino acid insertion in the KPC-2 protein causing structural changes proximal to the KPC-2 active site.

Keywords: Klebsiella pneumoniae; carbapenem; ceftazidime-avibactam; resistance; whole-genome sequencing, KPC-2.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Azabicyclo Compounds / therapeutic use
  • Bacterial Proteins / metabolism
  • Ceftazidime / therapeutic use
  • Drug Combinations
  • Drug Resistance, Bacterial
  • Humans
  • Klebsiella Infections / diagnosis
  • Klebsiella Infections / drug therapy*
  • Klebsiella pneumoniae / drug effects*
  • Klebsiella pneumoniae / genetics*
  • Klebsiella pneumoniae / isolation & purification
  • Microbial Sensitivity Tests
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use*
  • beta-Lactamase Inhibitors / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Azabicyclo Compounds
  • Bacterial Proteins
  • Drug Combinations
  • avibactam, ceftazidime drug combination
  • beta-Lactamase Inhibitors
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Ceftazidime