Trends and molecular characterization on beta-lactamase ESBL in Enterobacteriaceae in intraabdominal and urinary tract infections in Central America and Dominican Republic. The SMART study 2009-2013

Author(s):  
Silvio Vega Degracia
2019 ◽  
Vol 9 (2) ◽  
pp. 102-107 ◽  
Author(s):  
Anne Karmisholt Grosen ◽  
Johan Vestergaard Povlsen ◽  
Lars Erik Lemming ◽  
Simon Mark Dahl Jørgensen ◽  
Jens Frederik Dahlerup ◽  
...  

Renal transplant recipients (RTRs) are highly susceptible to infections, and antimicrobial resistance is an increasing problem with limited treatment options. Faecal microbiota transplantation (FMT) is effective for recurrent Clostridium difficile infection and may be used for patients with intestinal carriage of multidrug-resistant (MDR) microorganisms. We present a RTR who suffered from recurrent urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase-producing (ESBL+) Klebsiella pneumoniae. Blood and urinary isolates revealed the same antibiotic susceptibility pattern, and whole-genome sequencing confirmed identical isolates in blood and urine. Despite several treatments with meropenem, the patient experienced recurrent infections that caused hospitalisation. ESBL+ K. pneumoniae was isolated in faeces. In an attempt to decolonise the gut, FMT was performed. A few days after nasojejunal infusion of donor faeces, the patient experienced a single relapse of UTI. During the subsequent 12 months, no further episodes of UTI occurred. Absence of ESBL+ K. pneumoniae in urine and faeces was demonstrated during follow-up. We conclude that FMT may be an effective treatment in RTRs with recurrent UTIs caused by intestinal colonisation with MDR organisms.


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