Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Neonatal Bloodstream Infection with Ceftazidime-Avibactam-Resistant KPC-2 Producing- Klebsiella pneumoniae Carrying the VEB-25 Gene

Charalampos Zarras
ORCID logo ,
Elias Iosifidis
* ,
Maria Simitsopoulou
,
Styliani Pappa
,
Angeliki Kontou
ORCID logo ,
Emmanuel Roilides
,
Anna Papa
Version 1 : Received: 25 June 2023 / Approved: 26 June 2023 / Online: 26 June 2023 (09:40:12 CEST)

A peer-reviewed article of this Preprint also exists.

Zarras, C.; Iosifidis, E.; Simitsopoulou, M.; Pappa, S.; Kontou, A.; Roilides, E.; Papa, A. Neonatal Bloodstream Infection with Ceftazidime-Avibactam-Resistant blaKPC-2-Producing Klebsiella pneumoniae Carrying blaVEB-25. Antibiotics 2023, 12, 1290. Zarras, C.; Iosifidis, E.; Simitsopoulou, M.; Pappa, S.; Kontou, A.; Roilides, E.; Papa, A. Neonatal Bloodstream Infection with Ceftazidime-Avibactam-Resistant blaKPC-2-Producing Klebsiella pneumoniae Carrying blaVEB-25. Antibiotics 2023, 12, 1290.

Abstract

Buckground: Although ceftazidime/avibactam (CAZ/AVI) has become important option for treating adults and children, no recommendations exist for neonates. We report a neonatal sepsis case due to CAZ/AVI-resistant KPC-2 producing-Klebsiella pneumoniae carrying blaVEB-25 and the use of a customized active surveillance program in conjunction to infection control measures. Methods: The index case was an extremely premature neonate hospitalized for 110 days that had been previously treated with multiple antibiotics. Customized molecular surveillance was implemented at hospital level and enhanced infection control measures were taken for early recognition and prevention of outbreak. Detection and identification of blaVEB-25 was performed by next-generation sequencing. Results: That was the first case of a bloodstream infection caused by KPC producing K. pneumoniae that was resistant to CAZ/AVI without the presence of a metalo-β-lactamase in the multiplex PCR platform in a neonate. All 36 additional patients tested (12 in the same NICU and 24 from other hospital departments) carried wild-type blaVEB-1 but they did not harbor blaVEB-25. Conclusion: The emergence of VEB-25 is signal for horizontal transfer of plasmids at hospital facilities and it is of greatest concern for maintaining a sharp vigilance for surveillance of novel resistance mechanisms. Molecular diagnostics can guide appropriate antimicrobial therapy and early implementation of infection control measures against antimicrobial resistance.

Keywords

Multi-drug resistance; Gram-negative bacteria; Enterobacterales; carbapenemases

Subject

Medicine and Pharmacology, Epidemiology and Infectious Diseases

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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