Endogenous endophthalmitis caused by a multidrug-resistant hypervirulent Klebsiella pneumoniae strain belonging to a novel single locus variant of ST23: first case report in China

BMC Infectious Diseases

Ang Li¹  Yiqi Fu²  Weili Zhang³  Min Xu³  Hongchao Chen³  Haishen Kong³  Yajie Fu³ 

[1] Department of Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University;Department of Respiratory Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University;Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Center of Clinical Laboratory, the First Affiliated Hospital, College of Medicine, Zhejiang University;

关键词: Endophthalmitis;    Hypervirulent;    Klebsiella pneumoniae;    AmpC;    ESBL;   

DOI  :  10.1186/s12879-018-3543-5

来源: DOAJ

【 摘 要 】

Abstract Background Endogenous endophthalmitis caused by hypervirulent Klebsiella pneumoniae (HVKP) is an emerging infectious disease commonly with a devastating visual outcome. Most HVKP strains display a wild-type susceptibility profile to antibiotics. However, reports of antimicrobial-resistant HVKP have increased over time, which poses a serious therapeutic dilemma. Case presentation A 25-year-old man with a liver abscess and poorly controlled diabetes mellitus was admitted for endophthalmitis due to K. pneumoniae. The isolate displayed hypermucoviscosity as determined by a positive string test and exhibited resistance to ceftazidime, piperacillin-tazobactam and amikacin. Whole genome sequencing (WGS) analysis demonstrated the isolate to be a K1-serotype strain and belong to a novel single locus variant of ST23, ST2922. In addition to the virulence genes linked to HVKP, rmpA, magA, iucABCDiutA (aerobactin), ybtAPSTUX (yersiniabactin) and iroBDN (salmochelin), it was found to harbor extended-spectrum β-lactamase (ESBL) gene (bla CTX-M-14), AmpC β-lactamase gene (bla DHA), and 16S rRNA methylase gene (armA). Conclusions This is the first known case of endogenous endophthalmitis caused by a multidrug-resistant HVKP strain ever reported in China. Early diagnosis and treatment with intravenous and intravitreal injection of carbapenem were essential for a favorable visual outcome.

【 授权许可】

Unknown