693. Prosthetic Joint Infections due to Carbapenamase Producing Klebsiella pneumoniae: Clinical Outcomes
Session: Poster Abstract Session: Skin, Soft Tissue and Joint Infections
Friday, October 21, 2011
Room: Poster Hall B1
Background: 

Prosthetic joint infections (PJI) are the most serious complication of primary arthroplasties, occurring in less than 2% of the cases. They confer higher morbidity, prolonged hospital stay and additional cost of care. . Data are few regarding PJI due to multidrug resistant gram negative organisms. Carbapenamase producing Klebsiella pneumoniae (KPC) has emerged as a nosocomial pathogen, presenting a management challenge for medical and surgical caregivers. We present the clinical outcomes of three cases of KPC related PJI.

Methods: 

Retrospective chart review of patients with clinical culture isolates of KPC from 2007-2010.

Results: 

There were a total of 226 patients with positive cultures with KPC from 2007-2010. A total of 28 patients were identified to have a bone and joint related infection.  Only three cases were PJI. All three cases were total knee arthroplasties. KPC was a secondary pathogen in all three cases. The initial pathogen was MSSA in two cases and polymicrobial (vancomycin-resistant and susceptible enterococci and Proteus mirabilis) in the other case. One patient died despite aggressive medical and surgical management. The other two patients required multiple debridements, with above the knee amputation, in both cases and hip disarticulation in one.  Both survived, but with severe limitations of mobility. Side effects from KPC therapy were noted in one case with neurologic manifestations and renal failure secondary to colistimethate, cholestasis secondary to tigecycline and progressive hearing impairment secondary to amikacin. Resistance to colistimethate emerged during therapy in one case.

Conclusion: 

The clinical management of Carbapenamase producing Klebsiella pneumoniae PJI is challenging not only because of the virulence of the organism, but also the limited pharmacologic armamentarium.  As a result, such PJI may carry a high morbidity and unfortunately mortality. These cases highlight the opportunistic and chronic nature of KPC as a pathogen, and the need for aggressive combined medical and surgical treatment modalities.  Further investigation into management and new drug therapies for infections due to drug-resistant gram negative organisms are urgently needed.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Jorgelina de Sanctis, MD, Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH, Lucilea Texeira Johnson, MD, Infectious Disease, Cleveland Clinic, cleveland, OH, J. Walton Tomford, MD, Cleveland Clinic Foundation, Cleveland, OH and Steven K. Schmitt, MD, FIDSA, Cleveland Clinic, Cleveland, OH

Disclosures:

J. de Sanctis, None

L. Texeira Johnson, None

J. W. Tomford, None

S. K. Schmitt, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.