caa a22 4500 60615678X CHVBK 20210128100610.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s10096-015-2453-3 doi (NATIONALLICENCE)springer-10.1007/s10096-015-2453-3 Emergence of concurrent infections with colistin-resistant ESBL-positive Klebsiella pneumoniae and OXA-23-producing Acinetobacter baumannii sensitive to colistin only in a Romanian cardiac intensive care unit [Elektronische Daten] [D. Timofte, M. Dan, I. Maciuca, L. Ciucu, E. Dabija, E. Guguianu, C. Panzaru] We report the emergence and analysis of a cluster of concurrent infections/colonisations with colistin-resistant Klebsiella pneumoniae and OXA-23 carbapenemase-producing Acinetobacter baumannii in patients who had undergone cardiac surgery. We describe the emergence of colistin-resistant K. pneumoniae harbouring bla CTX-M-15, bla SHV-11, bla OXA-1, bla TEM-1 beta-lactamases and aac(6')-Ib-cr fluoroquinolone resistance. Colistin-resistant K. pneumoniae infections (pneumonia, wound infection, urinary tract infections and bacteraemia) occurred in critically ill patients previously treated with colistin for post-surgery infections with carbapenem-resistant Pseudomonas aeruginosa and/or A. baumannii. Although the cause of death could not be directly attributed to a single pathogen, three patients co-infected/colonised with K. pneumoniae, P. aeruginosa and/or A. baumannii died, whilst a fourth patient who had a mono-microbial infection with colistin-resistant K. pneumoniae only survived. The use of mobile intubation equipment in patients that shared the same ward, the clustering of cases over a short period of time, as well as the pulsed-field gel electrophoresis (PFGE) data all suggest cross-contamination between patients, either through equipment or by staff contact transmission. This report presents the ‘worst-case scenario' where concurrent infection/colonisation with pathogens exhibiting resistance to different types of last-resort antimicrobials occurred in some of the most debilitated intensive care unit (ICU) patients. Springer-Verlag Berlin Heidelberg, 2015 Timofte D. School of Veterinary Science, University of Liverpool, Leahurst Campus, CH64 7TE, Neston, Cheshire, UK aut Dan M. Institute of Cardiovascular Diseases, Iasi, Romania aut Maciuca I. School of Veterinary Science, University of Liverpool, Leahurst Campus, CH64 7TE, Neston, Cheshire, UK aut Ciucu L. Institute of Cardiovascular Diseases, Iasi, Romania aut Dabija E. Institute of Cardiovascular Diseases, Iasi, Romania aut Guguianu E. Faculty of Veterinary Medicine, University of Agronomical Sciences and Veterinary Medicine, Iasi, Romania aut Panzaru C. Institute of Cardiovascular Diseases, Iasi, Romania aut European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/10(2015-10-01), 2069-2074 0934-9723 34:10<2069 2015 34 10096 https://doi.org/10.1007/s10096-015-2453-3 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10096-015-2453-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Timofte D. School of Veterinary Science, University of Liverpool, Leahurst Campus, CH64 7TE, Neston, Cheshire, UK aut NATIONALLICENCE 700 1- Dan M. Institute of Cardiovascular Diseases, Iasi, Romania aut NATIONALLICENCE 700 1- Maciuca I. School of Veterinary Science, University of Liverpool, Leahurst Campus, CH64 7TE, Neston, Cheshire, UK aut NATIONALLICENCE 700 1- Ciucu L. Institute of Cardiovascular Diseases, Iasi, Romania aut NATIONALLICENCE 700 1- Dabija E. Institute of Cardiovascular Diseases, Iasi, Romania aut NATIONALLICENCE 700 1- Guguianu E. Faculty of Veterinary Medicine, University of Agronomical Sciences and Veterinary Medicine, Iasi, Romania aut NATIONALLICENCE 700 1- Panzaru C. Institute of Cardiovascular Diseases, Iasi, Romania aut NATIONALLICENCE 773 0- European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/10(2015-10-01), 2069-2074 0934-9723 34:10<2069 2015 34 10096