Use of high-dose ciprofloxacin for recurrent biofilm-forming multidrug-resistantKlebsiella pneumoniae bacteremia

Abstract

Introduction Klebsiella pneumoniae is a significant nosocomial pathogen. We aimed to assess the clinical success following high-dose ciprofloxacin for recurrent bacteremia from biofilm-forming multidrug resistant Klebsiella pneumoniae in a liver transplanted patient.Case report A 55-year-old male had undergone liver transplantation and at day 10 he developed fever and dysuria. Two blood cultures became positive and were identified by Vitek2 (BioMérieux, USA) as K. pneumoniae. From his urine K. pneumoniae was isolated. Based on antimicrobial susceptibility (AST) panel (Vitek2), i.v. meropenem 1 g 8 hourly and i.v. amikacin 15 mg/kg/ daily (5 days) were started (the isolate was ciprofloxacin-resistant). Following 14 days of meropenem he was discharged and 3 days later he was readmitted with fever and dysuria. Since the blood and urine isolate was K. pneumoniae, based on AST 21 days of meropenem were given, the patient was discharged and 3 days later he was readmitted with fever and dysuria. Since this was the 3 rd episode with K. pneumoniae bacteremia, to exclude the focus of infection contrast-enhanced computed tomography and 18 F-fluorodeoxyglucose-positron emission tomography were done but both were normal.Based on multilocus sequence typing (MLST) and microtiter plate assay, biofilm forming magA(K1)positive (+) K. pneumoniae CC23 was found. The patient was having continuous asymptomatic bacteriuria with similar (magA(K1)-positive (+) K. pneumoniae CC23) isolate; we opted for high dose oral ciprofloxacin (800 mg, 8 hourly) for 7 days.Conclusions Following a high dose of oral ciprofloxacin, we were able to achieve urinary microbial clearance and a permanent cure following (magA(K1)-positive (+) K. pneumoniae CC23) bacteremia.This could be a promising therapy to achieve microbial clearance from biofilm-forming multidrugresistant K. pneumoniae.

Biofilm Production and Porin Permeability Activity in Clinical Isolates of Ciprofloxacin-Resistant Klebsiella pneumoniae in the Tertiary Hospital in Purwokerto, Indonesia

“…Ciprofloxacin is the most effective antibacterial agent with a resistance rate of 27.8 % in Multi Drug Resistance (MDR) Staphylococcus aureus [24]. Major resistance mechanisms in K. pneumoniae decreased cell permeability from porin activity [25] and biofilm formation [26,27].…”