Multidrug-resistant Klebsiella oxytoca in post-surgical wound debridement: a clinical case report

Abstract

Introduction: Carbapenemase production is the main cause of resistance to carbapenem antibiotics in Enterobacteriaceae, including Klebsiella genre. Klebsiella oxytoca species is associated with bacteremia and infections of urinary tract, central nervous system, lungs, and soft tissues. This case reports the isolation of multidrug-resistant (MDR) Klebsiella oxytoca, a producer of KPC-type carbapenemase, from a debrided post-surgical wound in a geriatric patient. Klebsiella oxytoca, although known for its pathogenic potential, is not considered a common source of KPC production. Case description: An 84-year-old woman with a right femur fracture treated with arthroplasty developed a surgical infection. She was admitted to the emergency department with pain and seropurulent discharge from the post-surgical wound. Initially, ESBL Enterobacter cloacae was identified; however, later, KPC (carbapenemase)-producing MDR Klebsiella oxytoca was confirmed by the CARBA-5 NG-Test. Treatment was initiated with meropenem and amikacin, along with surgical debridement. Multidisciplinary management and rapid microbiological diagnosis allowed control of the infection. Conclusion: The detection of KPC-producing Klebsiella oxytoca underscores the importance of combating antimicrobial resistance through surveillance and the rational use of antibiotics, particularly in vulnerable patients. This case, uncommon in the literature, documents KPC-producing Klebsiella oxytoca in a postsurgical setting, reinforcing the need for comprehensive microbiological surveillance. Rapid tests such as the CARBA-5 NG-Test were key to rapidly identify resistance mechanism and guide treatment.