Inhibition of carbapenem-resistant NDM-1 Klebsiella pneumoniae isolated from a hospital outbreak patient by a synbiotic – A non-antibiotic treatment option?

Abstract

Objective: Klebsiella (K.) pneumoniae is globally responsible for an alarming increase in hospital infections especially, in intensive care units (ICUs). The acquisition of resistance against a broad range of antibiotics has turned infections with this pathogen into a major worldwide healthcare concern. The aim of the study was to investigate if multistrain synbiotics can complement the current treatment options of multidrug resistant K. pneumoniae infections.

Methods: Antimicrobial susceptibility and PCR testing was used to characterize the K. pneumoniae causing a hospital outbreak. Effect of multistrain synbiotic administration on the presence of K. pneumoniae in an infected patient was investigated by microbiological testing for the pathogen. Effects of the synbiotic mixture and its individual probiotic bacteria on K. pneumoniae isolated from patients and of the K. pneumoniae subsp. pneumoniae ATCC© 700603TM reference strain were investigated by pathogen in-vitro inhibition experiments.

Results: The outbreak K. pneumoniae strain was found to be resistant against a range of antibiotics including carbapenems, and to be a producer of New Delhi metallo-β-lactamase 1 (NDM-1). Treatment of a NDM-1 K. pneumoniae carrier with a multistrain synbiotic resulted in successful elimination of the pathogen from the patient. In-vitro inhibition experiments showed that the NDM-1 K. pneumoniae (and the reference strain K. pneumoniae subsp. pneumoniae, ATCC© 700603TM) could be effectively inhibited by the bacteria mixture of the synbiotic preparation.

Conclusion: Findings of the study indicate for the first time that a multistrain synbiotic can add to the treatment repertoire available for the management of NDM-1 K. pneumoniae infections.