First Case of Isolation of Pseudomonas Aeruginosa Producing Metallo-Group (Vim) and Serine-Group (Kpc) Carbapenemases Concomitantly During Icu Hospitalization in a Teaching Hospital in Paraná

Excessive use of antibacterial agents may lead to the selection of superbugs. An 81-year-old man with a history of colostomy performed eight years earlier due to colonic neoplasia was admitted on 05/07/25 with dark vomiting, abdominal pain, and distension. On the day of admission, he underwent exploratory laparotomy (EL) for obstructive acute abdomen. Antibiotic therapy with ceftriaxone and metronidazole was initiated. He remained hospitalized and, after seven days, developed new symptoms of colonic obstruction and signs of peritonitis, requiring a new EL. Culture of abdominal fluid was negative. Piperacillin–tazobactam was initiated after the EL. On 05/17, he was transferred to the Intensive Care Unit (ICU), intubated, and in septic shock with an abdominal focus. Tracheal aspirate culture (TAC) on 05/19 was negative. On 05/22, rectal swab culture detected Klebsiella pneumoniae producing KPC and Pseudomonas aeruginosa producing VIM (Pa-VIM). The patient was therefore placed in total isolation. On 05/25, he developed new abdominal-focus sepsis, with sudden leukocytosis from 16,000 to 36,000 cells/mm³ and left shift up to myelocytes. On the same day, antibiotic therapy was escalated to meropenem (double dose), vancomycin, and polymyxin B. Fifteen days after the start of antimicrobials, cultures from TA isolated carbapenem-resistant Acinetobacter baumannii and Pa-VIM+KPC concomitantly, representing the first KPC- and VIM-co-producing isolate in the region. The patient was afebrile, asymptomatic, with no radiological evidence of respiratory infection, and was clinically considered colonized according to ANVISA criteria [1]. Despite the presence of pathogens in the TA, as the patient remained stable and antibiotic therapy had completed 14 days of the expanded regimen, treatment was discontinued, with continued close observation. He was discharged from the ICU on 06/26. After 52 days of hospitalization, the patient remains afebrile, with no new microbial isolates, and is recovering slowly. We highlight the first isolation of a VIM-producing organism in this hospital, identified as Pa-VIM+KPC, with selection and dissemination of genes among isolates during treatment and hospitalization. This report reinforces the need for patient isolation to prevent dissemination, as no other patient in the hospital presented colonization or infection by VIM-producing isolates. Furthermore, it underscores the critical importance of the clinician’s ability to distinguish between infection and colonization by multidrug-resistant bacteria.