Ceftazidime/avibactam use for carbapenem-resistant Klebsiella pneumoniae meningitis: a case report

Abstract

were deposited in GenBank under accession numbers MF383355 and MF383354, respectively.Carbapenemase-producing (OXA-48 and OXA-181) Enterobacteriaceae isolates have been previously described in vegetables. 12,13o the best of our knowledge, this is the first report of either the bla NDM or bla KPC genes in bacteria from vegetables and also the first report of the coexistence of bla NDM-1 and bla KPC-2 in E. coli.Although the origin of bla NDM-1 and bla KPC-2 in vegetables is unclear, hospital wastewater or human sewage contamination might be sources.The isolate TS79e co-producing two carbapenemases showed extremely high-level resistance to imipenem and also carried several other important resistance genes (armA and fosA3), consistent with the results reported for clinical Enterobacteriaceae isolates that cause a significant challenge to clinical treatment. 2,5 Most importantly, the emergence of E. coli co-producing NDM-1 and KPC-2 in fresh vegetables is alarming, as vegetables such as lettuce are often consumed raw and might be a possible source from which humans could acquire clinically relevant resistance genes, such as bla NDM , bla KPC , armA and fosA3, thus posing a serious threat to public health.Appropriate measures, such as improving sewage treatment protocols and protecting irrigation water from faecal pollution, need to be taken to improve food safety.