The first case of revealing of Klebsiella pneumoniae ST147, producing NDM-1 carbapenemase, in trauma and orthopedic hospital in Russia

Abstract

Present report describes the first case of isolation of NDM-1 carbapenemase-producing K. pneumoniae in a patient with wound infection after open tibial fracture. Identical isolates were twice detected in various microbial associations: first time during therapy with ampicillin/sulbactam, second time after the relapse of wound infection during therapy with cephoperazone/sulbactam with vancomycin. The strain of K. pneumoniae was resistant to all beta-lactams, aminoglycosides and fluoroquinolones, but retained susceptibility to tigecycline and polymyxin B. The presence of blaNDM-1 was detected by PCR and Sanger sequencing. On the basis of multilocus sequence typing K. pneumoniae isolate was classified as sequence-type 147 (ST147). Eradication of the pathogen, successful osteosynthesis of tibial bones and skin-muscle flap plasty of the extensive wound were completed together with combined dioxydin and phosphomycin therapy. Due to the danger of the emergence of nosocomial infection sources and of the development of the potentially incurable nosocomial implant-associated infection, detection of NDM-1 carbapenemase-producing K. pneumoniae strain in a trauma and orthopedic in-patient clinic is alarming