Klebsiella pneumoniae Metallobetalactamase in the neonatology service of the Abel Santamaría Hospital: case report

Abstract

Introduction: Klebsiella pneumoniae is considered a superbacteria due to its extreme resistance to most antimicrobials and because it produces carbapenemases, enzymes that hydrolyze carbapenem antibiotics. This threat is exacerbated by the reduction in the discovery of new antibiotics.

Case presentation: Preterm newborn of 32,3 weeks of gestation and birth weight of 1790 grams, born on January 3, 2023 with mild neonatal depression and early sepsis due to coagulase-negative staphylococcus. It worsens, presenting jaundice, anemia and thrombocytopenia, with blood cultures positive for Enterobacter Gergoviae and later for Enterobacter agglomerans. Antibiotic therapy was based on different antibiograms depending on the germ isolated without presenting clinical improvement. The isolation obtained from Enterobacter aglomerans showed KPC resistance phenotype, so the sample was referred to the “Pedro Kouri” Institute of Tropical Medicine, where the growth of Klebsiella pneumoniae with NDM metallobetalactamase resistance phenotype was obtained, only Sensitive to colistin and Intermediate to phosphokine. Contact precautions and treatment with colistin and phosphokine are applied. As a result, the patient resolves the infection and it is not transmitted to other neonates in the service.

Conclusions: Klebsiella pneumoniae NDM infections constitute a danger due to the few therapeutic options, leaving colistin as the only alternative, due to resistance to carbapenems and due to the limitations in its identification in microbiology laboratories at the provincial level. The rational use of antimicrobials and microbiological surveillance are important for its control.