A patient in Victoria has died from a gram-negative infection that was resistant to all antibiotics.

Clinicians from St Vincent’s Hospital and the Royal Melbourne Hospital reported the case of a 59-year-old man from Victoria died from severe sepsis after becoming infected with carbapenemase-resistant Klebsiella pneumonia (CR-KP).

He was admitted to the hospital with severe acute pancreatitis secondary to gallstones and concurrent nosocomial pneumonia.

Doctors initially treated the patient with ceftriaxone, but the patient deteriorated and treatment was switched  to piperacillin-tazobactam and then meropenem.

Diagnostic microbiology did not reveal any significant pathogens.

But a pancreatic debridement revealed carbapenem-resistant Klebsiella pneumonia in the pancreatic tissue and the patient was prescribed gentamicin, doxycline, meropenem, ertapenem and fluconazole.

After no improvement the doctors applied for compassionate access to a new a new beta-lactamase inhibitor avibactam in combination with ceftazidime.

The antibiotics were supplied one week later and although the patient displayed some signs of improvement, microbiological clearance was not achieved and the patient later died.

The authors warned that Carbapenem-resistant Enterobacteriaceae (CRE) infections posed a clinical challenge particularly as the availability of effective antibiotics were limited in Australia.

“Given that early treatment may be effective in managing CRE infections, timely access to antibiotics such as ceftazidime-avibactam and associated antibiotic susceptibility testing in Australia is crucial,” they said.