# Community-Acquired Resistant Strain of Klebsiella pneumoniae in an Elderly Hispanic Patient in the United States: Causing Klebsiella-Invasive Syndrome With a Primary Liver Abscess and Antibiotic Resistance

## TL;DR

An elderly Hispanic woman in the U.S. developed a rare liver abscess caused by a drug-resistant Klebsiella pneumoniae strain, highlighting the challenges in diagnosing and treating such infections.

## Contribution

This case report documents a rare community-acquired Klebsiella liver abscess in a non-Asian U.S. patient with SHV ESBL resistance.

## Key findings

- The patient had a liver abscess caused by a SHV ESBL-producing Klebsiella pneumoniae strain.
- Treatment with ertapenem led to reduced abscess size and improved clinical outcomes.
- Community-acquired K. pneumoniae liver abscesses are rare in the Americas and pose diagnostic and therapeutic challenges.

## Abstract

Klebsiella pneumoniae (K. pneumoniae) commonly causes respiratory and urinary tract infections but can also lead to community-acquired liver abscesses, primarily in Asian populations. This condition is rare in the Americas and Europe. The emergence of sulfhydryl reagent variable extended-spectrum beta-lactamase (SHV ESBL) strains complicates the management of these abscesses. A Hispanic female in her late 60s presented with bloody urine after three weeks of foul odor, dry cough, headache, and blurry vision. A CT scan of the abdomen and pelvis showed a 1 cm right-sided ureteral calculus and a 5 cm focal liver density, later confirmed as a heterogeneous loculated abscess. A nephroureteral stent was placed. Ophthalmology ruled out endophthalmitis. Blood cultures showed K. pneumoniae, while urine cultures were negative. Cefepime was started based on sensitivity patterns. A CT-guided drain confirmed K. pneumoniae. Quantitative polymerase chain reaction (qPCR) and next-generation sequencing (NGS) revealed a positive SHV ESBL trait. Ertapenem was initiated due to the inability to specify the subtype. Persistent poor drainage prompted a drain change. Repeat imaging showed the reduced abscess size. The patient was discharged on six weeks of intravenous ertapenem with weekly lab tests. This case emphasizes the importance of vigilance for community-acquired Klebsiella liver abscesses in patients with K. pneumoniae infections. Managing liver abscesses, especially those caused by SHV ESBL strains, is challenging due to the lack of specific diagnostic tools. Broad-spectrum antibiotics such as carbapenems are cautiously used to prevent community resistance. Advancements in SHV ESBL studies are crucial for targeted therapy and appropriate antibiotic use.