Persistent carbapenem-resistant Klebsiella pneumoniae bacteremia in a patient with acute lymphoblastic leukemia.

A peripherally inserted central catheter line was inserted and the patient received the first part of induction chemotherapy according to the GMALL 06/1999 protocol. The treatment course was uneventful and bone marrow aspirate at the end of the course was compatible with complete remission. On day 3 after the initiation of the second part of the induction course, the patient became febrile (38.6oC) and antibiotic treatment with piperacillintazobactam was initiated according to the policy of our department, with defervescence. Two days later she became neutropenic. On day 10, breakthrough fever of 40oC occurred with the patient complaining of pain at the back of her right arm. The antimicrobial regimen was changed to meropenem and vancomycin and chemotherapy was withheld. Results of blood cultures obtained on day 10 were reported 3 days later and i nfections are highly prevalent in patients with hematological malignancies due to the underlying malignancy and/ or chemotherapy, and their prevention and treatment are a critical part of patient management. A substantial proportion of bacteria-causing infections among these patients are resistant to conventional, and sometimes also to, broad-spectrum antimicrobial agents. The treatment of such infectious episodes might be complex in face of both the patient’s underlying immunosuppression on the one hand and the pathogen’s virulence and the availability of effective antibacterial agents on the other. We present a case illustrating the dilemma of managing infections caused by multidrug-resistant bacteria in a severely immune-compromised patient.