Infect Chemother.  2019 Dec;51(4):399-404. 10.3947/ic.2019.51.4.399.

MCR1 and KPC2 Co-producing Klebsiella pneumoniae Bacteremia: First Case in Korea

Affiliations
  • 1Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 2Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
  • 3Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea. ktkwon@knu.ac.kr
  • 4Department of Laboratory Medicine, Daegu Fatima Hospital, Daegu, Korea.
  • 5Division of Antimicrobial Resistance, National Institute of Health, Centers for Disease Control and Prevention, Cheongju, Korea.

Abstract

Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) has been disseminating nationwide due to clonal spread and is taking a serious action at the national level in Korea. The mobilized colistin resistance (MCR1) gene confers plasmid-mediated resistance to colistin and is known to be capable of horizontal transfer between different strains of a bacterial species. We have experienced a fatal case of the patient who developed MCR1-possessing, ST307/Tn4401a[blaKPC2] K. pneumonia bacteremia in the community of non-capital region after being diagnosed as pancreatic cancer with multiple liver metastases and treated in the capital region. The ST307/Tn4401a[blaKPC2] K. pneumonia was the most commonly disseminated clone in Korea. Our strain is the first MCR1 and KPC2 co-producing K. pneumonia in Korea and our case is the critical example that the multi-drug resistant clone can cause inter-regional spread and the community-onset fatal infections. Fortunately, our patient was admitted to the intensive care unit on the day of visit, and the contact precaution was well maintained throughout and KPC-KP was not spread to other patients. The high risk patients for KPC-KP need to be screened actively, detected rapidly and preemptively isolated to prevent outbreak of KPC-KP. Inter-facility communications are essential and the nationwide epidemiologic data of KPC-KP should be analyzed and reported regularly to prevent spread of KPC-KP. The prompt identification of species and antimicrobial susceptibilities for successful treatment against KPC-KP should be emphasized as well.

Keyword

Carbapenem-Resistant Enterobactericeae; Carbapenemase; Colistin; Septic shock

MeSH Terms

Bacteremia*
Clone Cells
Colistin
Humans
Intensive Care Units
Klebsiella pneumoniae*
Klebsiella*
Korea*
Liver
Neoplasm Metastasis
Pancreatic Neoplasms
Pneumonia
Shock, Septic
Colistin
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