Emergence of KPC-producing hypervirulent Klebsiella pneumoniae in a case of fatal recrudescent liver abscess.
Kuenyoul Park, Mi-Na Kim, Eun Jeong Won et al.
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Case in brief
A 76-year-old man with pancreatic cancer developed septic shock from a recurrent liver abscess after a four-week course of cefepime. Initial abscess cultures had yielded Klebsiella pneumoniae without acquired resistance; during readmission, both carbapenem-susceptible and carbapenem-resistant strains were recovered from abscess and blood cultures. Genomic analysis identified the resistant strain as ST420, carrying bla KPC-2 and hypervirulence-associated genes, including aerobactin, salmochelin, and rmpA. Despite combination treatment with meropenem, amikacin, and colistin, he died.
What made this case unusual
The carbapenem-resistant ST420 strain combined bla KPC-2 with hypervirulence-associated genes. The report identifies this as the first reported hypervirulent CRKP of ST420 carrying bla KPC-2.
Diagnostic / clinical pearl
In recurrent liver abscess with sepsis, cultures may reveal both carbapenem-susceptible and resistant K. pneumoniae; genomic characterization can identify clinically important resistance and hypervirulence determinants.