19 April 2016

A man has died of a superbug infection that was resistant to all available antibiotics, indicating that Australia appears to have entered the post-antibiotic era. The ‘post-antibiotic era’ is a widely anticipated and warned-against time when the antibiotics that we have will no longer be effective against bacteria – because the bacteria have developed resistance to them.

The 59-year old patient from rural Victoria died from severe sepsis (blood poisoning) caused by bacteria called Klebsiella pneumoniae (carbapenem-resistant Klebsiella pneumoniae (CR-KP)) that were not susceptible to any antibiotics including those held as a last resort for severe infections.

Writing in the Medical Journal of Australia, doctors from St Vincent’s Hospital and the Royal Melbourne Hospital say the man might have been saved if he’d had early treatment with a new antibiotic combination of ceftazidime-avibactam, currently only available in the US. Supplies of the drug were sourced after all other antibiotics were tried, but too late to save the man who spent 5 months in hospital and underwent multiple rounds of antibiotic treatment in an effort to eliminate the superbug.

According to the report, the previously healthy man was admitted to hospital with severe acute pancreatitis due to gallstones and developed pneumonia.

He was initially treated with the antibiotics ceftriaxone, piperacillin-tazobactam and later meropenem, in line with hospital guidelines.

Diagnostic microbiology testing did not reveal any disease-causing microorganisms initially. After 2 months of unsuccessful treatment with a range of other antibiotics, further testing found carbapenem-resistant Klebsiella pneumoniae (CR-KP) in the pancreatic tissue. Carbapenems are antibiotics generally used as the last resort for these types of infections, so for the bacteria to be resistant to carbapenems means other antibiotics would have to be used.

Infectious disease specialists then tried various other antibiotic options including gentamicin combined with carbapenems, doxycycline and fluconazole, but the man’s condition deteriorated further.

The clinicians then tried to access supplies of a new antibiotic combination that contains a new beta-lactamase inhibitor, avibactam, and a third-generation beta-lactam, ceftazidime.

The drug, which was launched in the US in 2015 and is reported to cost $12,000 a course, was obtained via a compassionate access scheme from AstraZeneca, the manufacturer.

After receiving the drug, the man showed some improvement, but the bacteria were not eliminated.

In the fifth month, the patient was discharged home and died soon after.

The authors of the case report say the carbapenem-resistant bacteria now pose a major threat to Australia, given the lack of antibiotics to treat the pathogen.

Until recently the infection has been rare, with most cases brought to Australia by travellers from endemic countries, where the infection is established, they note.

However, the infection may become a threat if it becomes established in hospitals, where aquisition is linked to people who have a longer stay, receive broad-spectrum antibiotics and have invasive devices and nasogastric tubes.

Last Reviewed: 19/04/2016



Carbapenemase-producing Klebsiella pneumoniae: a major clinical challenge. MJA 2016; online.