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: Case report  Ecuador

[In Press] Multidrug-Resistant Klebsiella pneumoniae in a Patient with SARS-Cov-2 Pneumonia in an Intensive Care Unit in Guayaquil, Ecuador: A Case Report

Unusual clinical course

Betty J. Pazmiño Gómez1ACDE, Jennifer P. Rodas Pazmiño ORCID logo2BCDF, Gabriel S. González Quinde ORCID logo2BCEF, Jorge F. Guevara Viejó ORCID logo1BCF, Miguel J. Merejildo Amaguaña ORCID logo3BDF, Édgar I. Rodas Neira ORCID logo4CDEF, Francisco A. Rizzo Rodríguez ORCID logo5BDF, Luis E. Cagua Montaño ORCID logo1CDF, Karen A. Rodas Pazmiño ORCID logo1BDF

Am J Case Rep In Press; DOI:   :: ID: 936498

Available online: , In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Multi-resistant microorganisms are a public health problem. Their incidence has risen due to COVID-19, indiscriminate antibiotics use, corticosteroid treatments, and higher admissions to intensive care units (ICUs) of patients requiring invasive mechanical ventilation. These are risk factors for bacterial over-infection. The present case study that is relevant because of the multiple isolated strains with a resistance pattern: Klebsiella pneumoniae carbapenemases (KPC), extended-spectrum beta lactamases (ESBL) and New Delhi metallo-β-lactamase (NDM) in a patient without comorbidities.
A 53-year-old Ecuadorian man with no past medical history arrived at the Emergency Department (ED) with dyspnea, nasopharyngeal swab with a positive reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV2, and a chest computed tomography (CT) scan showing bilateral ground-glass pulmonary infiltrates with 40% involvement. On day 10 in the ICU, the presence of Klebsiella pneumoniae KPC strain was reported in an axillary swab culture. Consequently, the antibiotic was rotated to vancomycin 1 g intravenously (i.v.) every 12 h and meropenem 1 g i.v. every 8 h. On day 15 in the ICU, a tracheal secretion culture was reported with the presence of Klebsiella pneumoniae ESBL and a blood culture with Klebsiella pneumoniae NDM.
The COVID-19 pandemic is a perfect scenario for superinfection with multi-resistant pathogens such as carbapenem-resistant Klebsiella pneumoniae (CRKP), due to the increase in patients admitted to ICUs requiring invasive mechanical ventilation, the use of corticosteroids, and empirical broad-spectrum antibiotic management based on guidelines. The emergence of combined multidrug-resistant strains is a challenge for laboratory detection and the selection of antimicrobial treatment.

Keywords: COVID-19; Klebsiella pneumoniae; Pandemics; Respiration, Artificial


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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923