Bacteraemia caused by two different phenotypes of Klebsiella pneumoniae

© Journal of Emergency and Critical Care Medicine. All rights reserved. J Emerg Crit Care Med 2021 | http://dx.doi.org/10.21037/jeccm-21-15 A 74-year-old male was admitted to our intensive care unit (ICU) with high fever and shock. His medical history included poorly controlled blood sugar which led to the long-term complications of diabetes, including liver abscess for one year (Figure 1A,B,C,D). Chest computerized tomography (CT) scan, bronchoalveolar lavage (BAL), CTguided percutaneous catheter drainage (CTPCD) and blood sample culture were performed to detect the pathogenic microorganisms. Pulmonary fibrosis with infection was recognized in the chest CT (Figure 1E,F,G,H) and the morphology of the colony was mucous (Figure 2A,B,C) while two different colony forms in the agar plate were found (Figure 2D), one of which revealed the phenomenon of “Wire drawing” (Figure 2E). Finally, 4 strains of Klebsiella pneumoniae with different antimicrobial susceptibility were isolated from the blood, pus and bronchoalveolar lavage fluid (BALF) samples. Two of them were identified as carbapenem-resistant Klebsiella pneumoniae (CRKP) and the other two were carbapenem susceptible Klebsiella pneumoniae (CSKP) (Table S1). Pulsed-field gel electrophoresis (PFGE) was performed on the four isolates and sequence homology was found between the strains isolated from blood and BALF (ST-11, CRKP) while the other sequence homology was also detected between the strains isolated from blood and pus (ST-23, CSKP) (Figure 2F). Meropenem (intravenous medication, 2,000 mg q8h, and the trough Imaging in Emergency and Critical Care Medicine