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Microbes & Immunity Rare multi-site Klebsiella pneumoniae infections

infections, endophthalmitis, meningitis/brain abscesses, him unsuitable for more invasive operations, such as the
necrotizing fasciitis, osteomyelitis, and infections at removal of cerebral hematomas. Consequently, the patient
surgical sites. 6 was treated in the intensive care unit (ICU).
The prevalence of KP is particularly concerning in During the 31-day hospitalization period, the patient
areas with high population density and limited healthcare experienced a fever of up to 40ve Subsequently, the patient
resources, which exacerbate underlying conditions and developed septic shock, necessitating the administration
increase the incidence of infection. In nations like India, of vasopressors to stabilize blood pressure. Blood
the situation is critical due to the combination of dense tests unveiled a marked increase in white blood cell
health-care settings and suboptimal infection prevention count (WBC) (33.8×10 /L), indicative of an infection,
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measures, leading to a surge in antibiotic-resistant strains coupled with elevated levels of infection markers such
that complicate the treatment of infections and elevate as procalcitonin (PCT) (16.69 ng/mL) and C-reactive
morbidity and mortality rates. Similarly, countries in protein (CRP) (151.5 mg/L). Head and thorax CT scans
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South-east Asia, including Vietnam, face significant revealed the presence of multiple cavities in the brain
challenges with this pathogen, where environmental parenchyma and extensive consolidation in the lower lobe
factors and high population densities contribute to the dorsal segment of both lungs (Figure 1). Lumbar puncture
widespread transmission of infectious diseases. Local results demonstrated an opening pressure of 310 mm
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epidemiological data from these regions underscore the H O. The cerebrospinal fluid (CSF) appeared purulent
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critical need for enhanced surveillance and antibiotic and dark red, exhibiting a WBC of 3476/mm , a glucose
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stewardship to mitigate the spread of this pathogen. level of 0.8 mmol/L (blood glucose [BG]: 7.9 mmol/L),
Developed countries such as the United States of and a protein concentration of 13.34 g/L. An array of
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America also report cases of KP infections. However, their diagnoses was established, including hospital-acquired
advanced health-care infrastructure and stringent infection purulent meningitis, hospital-acquired pneumonia, septic
control protocols potentially offer better management shock, subarachnoid hemorrhage, and craniocerebral
and containment of outbreaks. The presence of KP in trauma. The treatment protocol encompassed intravenous
these countries highlights the bacterium’s adaptability administration of meropenem (2 g every 8 h) for 12 days,
and the global challenge posed by antibiotic resistance, supplemented by ventricular drainage. Notably, the KP
emphasizing the importance of international cooperation strain isolated from CSF exhibited sensitivity solely to
in sharing best practices for infection control and antibiotic carbapenems. Despite intensive treatment efforts, the
use. Treating infections caused by KP poses a significant patient’s condition did not improve, leading to his death
challenge, particularly in patients with diabetes or those from multiple organ failure.
with compromised immune systems.
A B
In this context, we examine the medical histories of
six patients treated at Shanghai General Hospital over the
past 3 years who suffered from KP infections. This paper
aims to highlight the critical need for accurate and rapid
diagnosis, as well as the initiation of appropriate treatment
in managing multi-site KP infections. Implementing
comprehensive treatment strategies is anticipated to yield
favorable clinical outcomes. C D

2. Case presentation
2.1. Case 1
A 23-year-old male worker experienced a one-hour
coma following a severe brain injury in our emergency
room. At the time of admission, he was in a deep coma,
and his Glasgow Coma Scale score was 3 (E1, V1, M1). Figure 1. The medical imaging findings of Case 1. (A and B) Subarachnoid
Computed tomography (CT) scans of the head and thorax hemorrhage and traumatic pulmonary contusion (on admission).
confirmed the presence of subarachnoid hemorrhage and (C) Head computed tomography (CT) scan revealed multiple cavities
in the brain parenchyma, accompanied by an indistinct demarcation
severe pulmonary contusion. Due to hypoxia and coma, between the cortex and medulla. (D) Chest CT revealed consolidation
the patient required intubation. His condition rendered (after 31 days of hospitalization).

Volume 1 Issue 1 (2024) 113 doi: 10.36922/mi.2600