Dr. Shubadeep Debabrata Sinha
Infectious Diseases
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My mother is 75 years old and was infected with Klebsiella microbes. In the beginning, she had vomiting, diarrhea, fever, and severe knee pain. She consulted multiple doctors from different specialties, and all agreed it was due to knee osteoarthritis. Still, at the same time, the white blood cells were about 24,000 per microliter, and no doctor found any explanation for this.
After 20 days, the pain was indescribable, and she was transferred to the hospital; there, she had blackness in the heel of her leg, and the doctors told us that it was gas gangrene. She had a leg cleaning surgery, but the doctor said that 70 percent of the tissues were affected, and she had to amputate the left leg above the knee. Indeed, after two days, the operation was completed. At that time, white blood cells approached 40,000 per microliter, and the day after the operation, it became 32,000 per microliter of blood, then 24,000 per microliter of blood, then 18,000 per microliterof blood, and suddenly it began to increase again and reached 20,000 per microliterof blood. After multiple examinations, the test showed that the microbe is called Klebsiella, a dangerous bacteria. The treatment is now using several antibiotics. She is a diabetic patient and took tablets before the last illness. She started taking insulin after the injury, and then she has atrial fibrillation in the heart and is taking medication for blood pressure.
I am attaching the details of the medicines and antibiotics used so far in treatment.
My question is, is there any better treatment available for this condition?
Thank you.
Hello,
Welcome to icliniq.com.
The following are my observations based on the history and reports (attachments removed to protect the patient's identity).
1. Your mother has been affected by a multidrug-resistant systemic bacterial infection.
2. She is a diabetes patient. The infective state was superimposed on uncontrolled diabetes, with medications not completely described (except a brand of Dapagliflozin and a mention of Insulin in your list, no doses described). It is unclear which subtype of diabetes mellitus she was suffering from and since when.
3. Gangrene of the left leg (leading to above knee amputation).
4. An episode of gastroenteritis (diarrhea, vomiting, and fever).
5. Infective knee osteoarthritis and joint infection of the knee superimposed on inflammation.
6. Complete blood picture - It appears that she had leukocytosis (increase in the count of white blood cells) and then decreased (due to possible infection control), and then started increasing again (possibly due to resistance development or reinfection from the hospital or new infection).
7. The causative bacteria are the Klebsiella group (possibly Klebsiella Pneumoniae). It is unclear which tissue or body fluid sample was used for bacterial culture.
8. Bacterial resistance and susceptibility are seen in the bacterial culture reports. A portion mentions the possible resistance and susceptibility of the bacteria to the different antibiotics. Based on the reports, antibiotics, possibly Meropenem and Linezolid (Zyvox), might have been selected for usage in the patient. Both antibiotics are used primarily in multidrug-resistant cases of bacterial infections
7. Cardiovascular conditions- She had hypertension and atrial arrhythmia (atrial fibrillation). The detailed clinical reports of these conditions such as two-dimensional or three-dimensional echocardiography (possibly with doppler for both hearts for central circulation and limbs for peripheral circulation), electrocardiogram (for arrhythmia and possibly ischaemic heart disease), and specific blood parameters (such as troponin, creatine phosphate kinase, and renal function tests for renal complications due to both hypertension and diabetes) are needed to understand the condition better.
Based on the above observations, it appears that she has been possibly prescribed and administered appropriate antibiotics (as mentioned above).
As you requested information on the other available antibiotics (you could also discuss them with the treating medical team), the other antibiotic options available include Carbapenems, Doripenem, Imipenem, and its combinations with Cilastatin, Vancomycin, and antibiotics against Vancomycin-resistant enterobacteria or enterococci (VRE). Antibiotics against VRE include Linezolid and Quinupristin or Dalfopristin, Daptomycin, Oritavancin, and Tigecycline. In addition, certain new cephalosporins, such as Ceftaroline and Ceftobiprole, are also used. All the above antibiotics are used based on clinical evidence generated from tissue, blood, body fluid culture, antimicrobial sensitivity reports, and appropriate clinical judgment of the treating physicians, infectious disease specialists, clinical intensive care specialists, and the treating surgeons responsible. You can start the possible antibiotics after discussing them with the specialist doctor and with their consent.
I hope I was helpful to you.
Thank you.
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Infectious Diseases
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