Successful treatment of carbapenemase producing Enterobacteriaceae peritonitis: 'Old therapy for a new bug'

Area of Science:

• Infectious Diseases
• Microbiology
• Nephrology

Background:

• Multidrug-resistant organisms (MDROs) pose a significant global health challenge, leading to increased morbidity and mortality.
• Carbapenem antibiotics were once the primary treatment for resistant Enterobacteriaceae infections, including those producing extended-spectrum β-lactamases.
• The emergence of carbapenem-resistant Enterobacteriaceae (CRE) necessitates alternative therapeutic strategies due to their resistance to most β-lactam antibiotics, including carbapenems.

Observation:

• A case study involving an 84-year-old female patient undergoing peritoneal dialysis (PD) for three years.
• The patient developed peritonitis caused by carbapenem-resistant Klebsiella pneumoniae.
• Klebsiella pneumoniae is a Gram-negative bacillus known for its increasing resistance to antibiotics.

Findings:

• The patient's infection was successfully treated with colistin, an antimicrobial agent.
• Colistin, first introduced in the 1950s, demonstrated efficacy against a carbapenem-resistant Klebsiella pneumoniae strain.
• Different carbapenemases exhibit varying resistance profiles, highlighting the need for tailored treatment approaches.

Implications:

• This case highlights the potential utility of older antibiotics like colistin in managing challenging multidrug-resistant bacterial infections.
• Successful colistin treatment in PD peritonitis caused by CRE offers a viable option for patients with limited therapeutic choices.
• Further research into the re-purposing and optimization of older antimicrobial agents is warranted to combat the rising threat of antibiotic resistance.