Author/Authors :
Wilkowski Piotr نويسنده Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland , Ciszek Michal نويسنده Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland , Dobrzaniecka Kornelia نويسنده Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland , Wojtowicz Monika نويسنده Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland , Wasiak Dariusz نويسنده Department of Surgical and Transplantation Nursing, Warsaw Medical University, Warsaw, Poland , Mlynarczyk Grazyna نويسنده Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland , Paczek Leszek نويسنده Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
Abstract :
[Introduction]An increase in the number of infections with Klebsiella pneumoniae producing Extended-Spectrum β-Lactamase (ESBL+) is a clinical issue, because there are no guidelines regarding the correct choice of an antibiotic and duration of treatment in kidney transplant recipients. The bacterial capacity to degrade almost all β-lactam antibiotics, except carbapenems, causes resistance to standard treatment and makes long-term intravenous antibiotic therapy necessary.[Case Presentation]This report describes the case of a 44-year-old patient after kidney transplantation, who developed recurrent urinary tract infections (UTIs) caused by ESBL-producing K. pneumoniae despite prolonged antibiotic targeted treatments with imipenem/cilastatin, meropenem, imipenem/cilastatin with amikacin and oral phosphomycin for UTI prophylaxis. Ineffectiveness of previous treatments caused the necessity to use a non-standard therapy of the consecutive UTI episode with high doses of amoxicillin combined with standard doses of clavulanic acid to break the bacteria’s resistance. There was no recurrence of UTI and control urine cultures were sterile over the entire course of treatment, lasting 165 days, and throughout the follow-up period of more than 1 year.[Conclusions]It has been shown in this case that UTI with the aetiology of K. pneumoniae could be treated on an outpatient basis with high doses of amoxicillin in combination with standard doses of clavulanic acid followed by prolonged antibiotic prophylaxis.
