Decreased susceptibility to polymyxin B during treatment for carbapenem-resistant Klebsiella pneumoniae infection.

摘要

In the United States, the major mechanism of carbapenem resistance among Enterobacteriaceae is the production of Klebsiella pneumoniae carbapenemase (KPC) (2). Polymyxins and tigecycline are the antimicrobials most often used for treatment of infections caused by carbapenem-resistant Enterobacteriaceae (4, 11). Polymyxin B, discovered more than 60 years ago, has been reintroduced as a valuable therapeutic agent with efficacy against multidrug-resistant gram-negative bacteria due to a shortage of new antimicrobials with activities against these organisms. While polymyxin B resistance has been observed in clinical isolates of carbapenem-resistant K pneumoniae (CRKP), reports of developing resistance in vivo during treatment with polymyxin B are limited (1, 8).