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Development of Klebsiella pneumoniae resistance: case report A man [age at the time of reaction onset not stated] developed Klebsiella pneumoniae resistance during treatment with gentamicin and imipenem for Klebsiella pneumoniae carbapenemase producing K. pneumoniae. The man, who underwent sphincteroscopy in September 2009, got contaminated with an endoscope-borne Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp). Subsequently, he received antimicrobial treatment with gentamicin and imipenem [routes and dosages not stated]. In 2013, he was diagnosed with bladder cancer and a prostatic adenocarcinoma. In 2014, a week following a cystoprostatectomy, infectious complications with peritonitis secondary to a breach in the Bricker anastomosis occurred. He suffered from recurrent cholangitis because of repetitive lithiasis. Until 29 April 2014, 17-KPC-Kp isolates were collected from him (S1–S17). Kp BIC-1 and the first 6 isolates were found to be susceptible to gentamicin; however, six later isolates (S7–S11 and S15) shifted to gentamicin resistance with an increased susceptibility to amikacin. Single nucleotide polymorphism analysis showed the presence of a point mutation in the aac(6ʹ)-Ib gene carried by pBIC-1c, leading to a L119S amino acid change of the AAC(6ʹ)-Ib enzyme in all the gentamicin-resistant isolates. This appeared subsequent to a 10-day treatment with imipenem and gentamicin, and was stable over time. Sepsis secondary to a polymicrobial infection with intestinal bacteria including KPC-Kp was followed by multivisceral failure and death. Author comment: "Regarding aminoglycoside susceptibility, we reported a in vivo mutation in the aac(6ʹ)-Ib gene that conferred resistance to gentamicin. It appeared subsequent to a 10-day treatment with imipenem and gentamicin, and was stable over time." Jousset AB, et al. A 4.5-Year Within-Patient Evolution of a Colistin-Resistant Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae Sequence Type 258. Clinical Infectious Diseases 67: 1388-1394, No. 9, 15 Oct 2018. Available 803434726 from: URL: http://doi.org/10.1093/cid/ciy293 - France

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Reactions 23 Nov 2019 No. 1780