Successful Treatment of an AML Patient Infected with Hypervirulent ST463 Pseudomonas Aeruginosa Harboring Rare Carbapenem-Resistant Genes blaAFM-1 and blaKPC-2 Following Allogeneic Hematopoietic Stem Cell Transplantation

Yingying Shen; Junmin Cao; Tonglin Hu; Xiawan Yang; Yuechao Zhao; Yiping Shen; Baodong Ye; Yunsong Yu; Dijiong Wu

doi:10.2147/IDR.S455746

Successful Treatment of an AML Patient Infected with Hypervirulent ST463 Pseudomonas Aeruginosa Harboring Rare Carbapenem-Resistant Genes blaAFM-1 and blaKPC-2 Following Allogeneic Hematopoietic Stem Cell Transplantation

Infect Drug Resist. 2024 Apr 6:17:1357-1365. doi: 10.2147/IDR.S455746. eCollection 2024.

Authors

Yingying Shen^#^{1

2}, Junmin Cao^#³, Tonglin Hu^{1

2}, Xiawan Yang^{1

2}, Yuechao Zhao^{1

2}, Yiping Shen^{1

2}, Baodong Ye^{1

2}, Yunsong Yu⁴, Dijiong Wu^{1

2}

Affiliations

¹ Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, People's Republic of China.
² National Traditional Chinese Medicine Clinical Research Base (Hematology), Hangzhou, Zhejiang, People's Republic of China.
³ Department of Clinical Laboratory, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, People's Republic of China.
⁴ Department of Infectious Diseases, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China.

^# Contributed equally.

Abstract

Background: Carbapenem-resistant P. aeruginosa (CRPA) is a common hospital-acquired bacterium. It exhibits high resistance to many antibiotics, including ceftazidime/avibactam and cefteolozane/tazobactam. The presence of carbapenem-resistant genes and co-existence Klebsiella pneumoniae carbapenemase (KPC) and metallo-β-lactamases (MBLs) further inactivated all β-lactams. Understanding the resistance genes of CRPA can help in uncovering the resistance mechanism and guiding anti-infective treatment. Herein, we reported a case of perianal infection with hypervirulent ST463 Pseudomonas aeruginosa.

Case presentation: The case is a 32-year-old acute myeloid leukemia (AML) patient with fever and septic shock during hematopoietic stem cell transplantation (HSCT), and the pathogen was finally identified as a highly virulent sequence type 463 (ST463) P. aeruginosa harboring carbapenem-resistant genes bla_AFM-1 and bla_KPC-2, which was detected in the bloodstream and originated from a perianal infection. The strain was resistant to ceftazidime/avibactam but successfully treated with polymyxin B, surgical debridement, and granulocyte engraftment after HSCT. The AML was cured during the 19-month follow-up.

Conclusion: This case emphasizes the importance of metagenomic next-generation sequencing (mNGS) and whole-genome sequencing (WGS) in identifying microbes with rare resistant genes, and managing CRPA, especially in immunocompromised patients. Polymyxin B may be the least resistant option.

Keywords: ST463; blaAFM; blaKPC; carbapenem-resistant pseudomonas aeruginosa.

Publication types

Case Reports

Grants and funding

This study was supported by Zhejiang Provincial Natural Science Foundation (NO.LY21H290003), Zhejiang Traditional Chinese Medicine Scientific Research Foundation (NO. 2020ZB085), Science and Technology Department of Zhejiang Research Foundation (NO.2019C03047), Project of Academic Inheritance Studio of Famous and Aged Chinese Medicine Experts in Zhejiang Province (NO.GZS2021022), Specific Program of Scientific Research of Zhejiang Chinese Medicine University for Affiliated Hospital (NO. 2023FSYYZZ04), Science and Technological Innovation Project for College Students in Zhejiang Province (Xinmiao Talent Plan) (NO. 2023R410003), Zhejiang Medical and Health Science and Technology Plan Project (NO. 2023RC193) and National Natural Science Foundation of China (NO.82304937).