Treatment analysis of acute fatty liver of pregnancy complicated with hematogenous infection of CRKP

doi:10.5246/jcps.2020.08.055

Journal of Chinese Pharmaceutical Sciences ›› 2020, Vol. 29 ›› Issue (8): 591-595.DOI: 10.5246/jcps.2020.08.055

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Treatment analysis of acute fatty liver of pregnancy complicated with hematogenous infection of CRKP

Lixia Li¹, Feng Chen², Xiaomei Xue³, Fan Yang⁴, Bin He^3*

1. Department of Pharmacy, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
2. Department of Clinical Laboratory, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
3. Department of Anesthesiology and SICU, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
4. Institute of Antibiotics of Huashan Hospital, Fudan University, Shanghai 200040, China

Received:2020-03-06 Revised:2020-04-29 Online:2020-08-31 Published:2020-05-16
Contact: Tel.: +86-21-25077826, E-mail: hebin@xinhuamed.com.cn
Supported by:
National Natural Science Foundation of China (Grant No. 81470390); Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support (Grant No. 20152218); Shanghai Sailing Program (Grant No. 19YF1431700); Clinical Trial of Xinhua Hospital (Grant No. 15LC11).

Abstract

Abstract:

Acute fatty liver of pregnancy (AFLP) is an idiopathic disease with acute and critical onset. Although the incidence of AFLP is relatively low, its mortality remains high. When AFLP is complicated with multi-organ dysfunction syndrome (MODS) and severe infection, especially hematogenous infection caused by multidrug-resistant pathogens, treatment becomes extremely difficult with an even lower survival rate. In the present work, we reported a 31-year-old primipara woman who developed AFLP complicated with MODS and severe infection at 37⁺⁵ weeks of gestation and received treatment in our hospital. The result of fast blood culture was positive for carbapenem-resistant Klebsiella pneumonia (CRKP). Based on this finding in combination with the results of drug sensitivity test, the quadruple regime using scheme imipenem cilastatin sodium, tigecycline, polymyxin and fosfomycin was implemented, and the patient was successfully cured. Successful treatment of pregnant women with AFLP complicated with MODS and/or hematogenous infection of CRKP can be achieved by using individualized combined antibiotic therapies on the basis of fast blood culture and combined drug sensitivity test. In this case, the patient was in a critical situation. In the treatment process, clinicians, clinical pharmacists and microbiologists should cooperate with each other and discuss the treatment plan together according to the pathophysiological characteristics of the patient, which was one of the key factors for successful treatment of the patient.

Key words: Pregnant woman, Acute fatty liver of pregnancy, Carbapenem-resistant Klebsiella pneumonia, Hematogenous infection

CLC Number:

Supporting:

Lixia Li, Feng Chen, Xiaomei Xue, Fan Yang, Bin He. Treatment analysis of acute fatty liver of pregnancy complicated with hematogenous infection of CRKP[J]. Journal of Chinese Pharmaceutical Sciences, 2020, 29(8): 591-595.

References

[1] Mellouli, M.M.; Amara, F.B.; Maghrebi, H.; Bouchnack, M.; Khaled, N.; Reziga, H. Acute fatty liver of pregnancy over a 10-year period at a Tunisian tertiary care center. Int. J. Gynaecol. Obstet. 2012, 117, 88-89.

[2] Knight, M.; Nelson-Piercy, C.; Kurinczuk, J.J.; Spark, P.; Brocklehurst, P.; UK Obstetric Surveillance System. A prospective national study of acute fatty liver of pregnancy in the UK. Gut. 2008, 57, 951-956.

[3] Martin Jr, J.N.; Briery, C.M.; Rose, C.H.; Owens, M.T.; Bofill, J.A.; Files, J.C. Postpartum plasma exchange as adjunctive therapy for severe acute fatty liver of pregnancy. J. Clin. Apher. 2008, 23, 138-143.

[4] Ibdah, J.A.; Bennett, M.J.; Rinaldo, P.; Zhao, Y.; Gibson, B.; Sims, H.F.; Strauss, A.W. A fetal fatty-acid oxidation disorder as a cause of liver disease in pregnant women. N. Engl. J. Med. 1999, 340, 1723-1731.

[5] Liu, J.X.; Yu, J.; Chen, F.; Yu, J.J.; Simner, P.; Tamma, P.; Liu, Y.; Shen, L.S. Emergence and establishment of KPC-2-producing ST11 Klebsiella pneumoniae in a general hospital in Shanghai, China. Eur. J. Clin. Microbiol. Infect. Dis. 2018, 37, 293-299.

[6] Liu, Y.Y.; Wang, Y.; Walsh, T.R.; Yi, L.X.; Zhang, R.; Spencer, J.; Doi, Y.; Tian, G.B.; Dong, B.L.; Huang, X.H.; Yu, L.F.; Gu, D.X.; Ren, H.W.; Chen, X.J.; Lv, L.; He, D.D.; Zhou, H.W.; Liang, Z.S.; Liu, J.H.; Shen, J.Z. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. Lancet Infect. Dis. 2016, 16, 161-168.

[7] Ye, R.X.; Ji, J.S.; Shi, K.R.; Jiang, Y.; Yu, Y.S. Antimicrobial activity of fosfomycin combined with tigecycline against Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae. Chin. J. Infec. Dis. 2014, 32, 522-527.

[8] Samonis, G.; Maraki, S.; Karageorgopoulos, D.E.; Vouloumanou, E.K.; Falagas, M.E. Synergy of fosfomycin with carbapenems, colistin, netilmicin, and tigecycline against multidrug-resistant Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa clinical isolates. Eur. J. Clin. Microbiol. Infect. Dis. 2012, 31, 695-701.

[9] Barth, N.; Ribeiro, V.B.; Zavascki, A.P. In vitro activity of polymyxin B plus imipenem, meropenem, or tigecycline against KPC-2-producing Enterobacteriaceae with high MICs for these antimicrobials. Antimicrob. Agents Chemother. 2015, 59, 3596-3597.

[10] Toledo, P.V.; Aranha Junior, A.A.; Arend, L.N.; Ribeiro, V.; Zavascki, A.P.; Tuon, F.F. Activity of antimicrobial combinations against KPC-2-producing Klebsiella pneumoniae in a rat model and time-kill assay. Antimicrob. Agents Chemother. 2015, 59, 4301-4304.

[11] Morrill, H.J.; Pogue, J.M.; Kaye, K.S.; LaPlante, K.L. Treatment options for carbapenem-resistant Entero-bacteriaceae infections. Open Forum Infect. Dis. 2015, 2, ofv050.

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Treatment analysis of acute fatty liver of pregnancy complicated with hematogenous infection of CRKP

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