Meropenem-Vaborbactam as Salvage Therapy for Ceftazidime-Avibactam-Resistant Klebsiella pneumoniae Bacteremia and Abscess in a Liver Transplant Recipient.

Abstract	We report a case of a 24-year-old liver transplant recipient who developed hepatic artery thrombosis and graft failure, which was complicated by subphrenic abscess and persistent Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae bacteremia. Ceftazidime-avibactam treatment led to emergence of resistance, and alternative combination therapy failed due to persistent infection and toxicity. The infection resolved after initiation of meropenem-vaborbactam, which created a bridge to retransplantation. Treatment-emergent ceftazidime-avibactam resistance is increasingly recognized, suggesting a role for meropenem-vaborbactam.
Authors	Vasilios Athans, Elizabeth A Neuner, Habiba Hassouna, Sandra S Richter, George Keller, Mariana Castanheira, Kyle D Brizendine, Amy J Mathers
Journal	Antimicrobial agents and chemotherapy (Antimicrob Agents Chemother) Vol. 63 Issue 1 (01 2019) ISSN: 1098-6596 [Electronic] United States
PMID	30578403 (Publication Type: Case Reports, Journal Article)
Copyright	Copyright © 2018 American Society for Microbiology.
Chemical References	Anti-Bacterial Agents Azabicyclo Compounds Bacterial Outer Membrane Proteins Bacterial Proteins Boronic Acids Drug Combinations Heterocyclic Compounds, 1-Ring avibactam, ceftazidime drug combination meropenem and vaborbactam Ceftazidime beta-Lactamases carbapenemase Meropenem
Topics	Anti-Bacterial Agents (pharmacology, therapeutic use) Azabicyclo Compounds (pharmacology) Bacteremia (drug therapy) Bacterial Outer Membrane Proteins (genetics) Bacterial Proteins (metabolism) Boronic Acids (therapeutic use) Carbapenem-Resistant Enterobacteriaceae (isolation & purification) Ceftazidime (pharmacology) Drug Combinations Drug Resistance, Multiple, Bacterial Hepatic Artery (pathology) Heterocyclic Compounds, 1-Ring (therapeutic use) Humans Klebsiella Infections (drug therapy) Klebsiella pneumoniae (drug effects, genetics) Liver Transplantation (adverse effects) Male Meropenem (therapeutic use) Microbial Sensitivity Tests Salvage Therapy (methods) Thrombosis (pathology) Young Adult beta-Lactamases (metabolism)

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