AUTHOR=de Campos Tatiana Amabile , Gonçalves Laura Fernandes , Magalhães Kelly Grace , de Paulo Martins Vicente , Pappas Júnior Georgios Joannis , Peirano Gisele , Pitout Johann D. D. , Gonçalves Guilherme Bartolomeu , Furlan João Pedro Rueda , Stehling Eliana Guedes , Pitondo-Silva André TITLE=A Fatal Bacteremia Caused by Hypermucousviscous KPC-2 Producing Extensively Drug-Resistant K64-ST11 Klebsiella pneumoniae in Brazil JOURNAL=Frontiers in Medicine VOLUME=5 YEAR=2018 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2018.00265 DOI=10.3389/fmed.2018.00265 ISSN=2296-858X ABSTRACT=

We report a fatal bacteremia caused by Klebsiella pneumoniae in a 60–70-year-old patient from Brazil. The genomic analysis of three isolates (from blood culture, nasal and anal swabs) showed that the bacteremia was caused by a KPC-2 producing extensively drug-resistant K64-ST11 hypermucousviscous K. pneumoniae (hmKP) harboring several virulence and antimicrobial resistance genes. Although the isolates did not present virulence markers associated with hypervirulent K. pneumoniae (hvKP), they showed invasion and toxicity to epithelial Hep-2 cells; resistance to cell microbicidal mechanisms; and blood and human serum survival, evidencing their pathogenic potential. This study highlights the risk of infection caused by hmKp strains not characterized as hvKP as well as the clinical implications and difficulty of treatment, especially in elderly or immunocompromised patients.