Acute mastoiditis caused by Klebsiella pneumoniae carbapenemase (KPC) producing bacteria – an atypical cause

TL;DR

This paper reports a rare case of acute mastoiditis caused by KPC-producing bacteria in an immunosuppressed adult.

Contribution

The case highlights an atypical cause of acute mastoiditis not commonly reported in medical literature.

Findings

Acute mastoiditis caused by KPC-producing bacteria is rare and typically occurs post-surgery or trauma.

The patient was successfully treated with intravenous colistin based on antibiotic susceptibility testing.

KPC infections are increasing, especially in immunosuppressed individuals, and carry high mortality and healthcare costs.

Abstract

The aim of this report is to present a rare case of acute mastoiditis caused by Klebsiella (K.) pneumoniae carbapenemase (KPC) producing bacteria.

The following report describes a 78-year-old immunosuppressed female who was hospitalized due to left-sided acute otitis media complicated by tympanic membrane rupture and acute mastoiditis. Fluid-discharge culture revealed KPC. The patient successfully received four weeks of conservative treatment with intravenous colistin (based on antibiotic susceptibilities).

Acute mastoiditis is a rare complication of acute otitis media, mostly seen in pediatric populations. The most frequent causative agents identified are Gram-positive cocci such as Streptococcus (S.) pyogenes and S. pneumoniae. Acute mastoiditis caused by KPC-producing bacteria has rarely been reported in medical literature, with most such infections observed following neurosurgical surgeries and/or post-trauma.

The incidence of infection by KPC is rising, especially in immunosuppressed patients and those with recent and/or prolonged hospitalizations. There are very few reports in the literature describing acute mastoiditis caused by KPC. Infection with KPC not only has a high 30-day mortality rate (up to 40%) but also poses a significant financial burden on the healthcare system.