Klebsiella pneumoniae carrying bla NDM-1 gene in orthopedic practice

Area of Science:

• Microbiology
• Infectious Diseases
• Orthopedic Surgery

Background:

• Carbapenemase-producing Enterobacteriaceae (CPE) pose a global health threat.
• New Delhi metallo-β-lactamase (NDM-1) is a significant carbapenemase of concern.
• Enterobacteriaceae infections are common in orthopedic settings.

Purpose of the Study:

• To report a case of NDM-1-producing Klebsiella pneumoniae infection in an orthopedic patient.
• To highlight the challenges in managing infections caused by carbapenem-resistant organisms.
• To document the antimicrobial susceptibility profile of the NDM-1 isolate.

Main Methods:

• Case report of an orthopedic patient with femur fracture.
• Identification of Klebsiella pneumoniae from a secondary infection.
• Antimicrobial susceptibility testing, including Minimum Inhibitory Concentration (MIC) for imipenem using E-test.
• Phenotypic and genotypic detection of the bla NDM-1 gene.

Main Results:

• The patient developed a secondary Klebsiella pneumoniae infection post-femur fracture management.
• The isolate demonstrated high-level resistance to imipenem (MIC ≥8 μg/ml), indicating carbapenemase production.
• Confirmation of the bla NDM-1 gene through genotypic analysis.
• The NDM-1 producing Klebsiella pneumoniae isolate was susceptible only to tigecycline, colistin, and polymyxin B.

Conclusions:

• NDM-1 producing Enterobacteriaceae can cause serious infections in orthopedic patients.
• Effective management requires accurate diagnostics and knowledge of limited therapeutic options.
• Antimicrobial stewardship is crucial to combat the spread of carbapenem resistance.