4. A patient is admitted to the hospital with injuries from a hiking accident. T

Question

4. A patient is admitted to the hospital with injuries from a hiking accident. The patient has several broken bones and deep cuts. He is treated with antibiotics to prevent possible infection and responds well showing no antibiotic resistance. However during his hospital stay he develops pneumonia caused by Klebsiella carrying the KPC gene. Luckily he responds to high dosage antibiotic treatment and discharged. Two months later, the patient is admitted to hospital again this time with a urinary tract infection caused by KPC resistant E. coli. Explain how the patient first, could have contracted the Klebsiella infection during their hospital stay and second how the E. coli bacteria acquired the KPC resistance when the patient showed no antibiotic resistance when first admitted to the hospital. (6 marks)

Explanation / Answer

Klebsiella Pneumonia is a gram-negative bacillus belongs to Enterobacteriaceae member and involved in the carbapenems antibiotics resistance (KPC) and this resistant was shown to other antibiotics like beta-lactams including penicillin, cephalosporins, and monobactams.

In our statement, this KPC previously it was not there in the patient but during treatment in the hospital (staying) there might be chance of getting this Klebsiella in to the patient (nosocomial infections-hospitably acquired infections) from contaminated air (through ventilators of hospital) or through direct contact from contaminated blood and its products or instruments used in the treatment (accident case). Once, the Klebsiella enter into the body (through the air into the lungs of the infected individual) and establishes the disease in the lungs called pneumonia. However, initially, he was responded well to the antibiotics and cured well and went home (discharged from hospital).

After two months, he got urinary tract infection from E. coli that it is resistant to KPC, how it possible?

1. One possibility is that not only klebsiella has the KPC but it is common in Enterobacteriaceae members, one of them is E. coli.

2. Another possibility is that this KPC encoded by the gene blaKPC, it has more potential to transfer from one bacterial species to another species (inter-species) with the help of transposons. Furthermore, this gene (blaKPC) present within a Tn3-type transposon (Tn4401). This transposon is a genetic element which is capable of inserting into diverse plasmids of Gram-negative bacteria. Due to that, there is a chance of transfer of this gene from Klebsiella to E.coli or through conjugation (or horizontal gene transfer mechanisms).

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