Emergence of Resistance to Colistin During the Treatment of Bloodstream Infection Caused by Klebsiella pneumoniae Carbapenemase-Producing Klebsiella pneumoniae

Open Forum Infect Dis. 2018 Apr 23;5(4):ofy054. doi: 10.1093/ofid/ofy054. eCollection 2018 Apr.

Abstract

We report the emergence of colistin resistance in Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae after 8 days of colistin-based therapy, resulting in relapse of bloodstream infection and death. Disruption of the mgrB gene by insertion of a mobile genetic element was found to be the mechanism, which was replicated in vitro after exposure to subinhibitory concentrations of colistin and meropenem.

Keywords: Klebsiella pneumoniae; carbapenemase; colistin resistance.