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Presentation

An 86-year-old woman with a remote history of right total knee arthroplasty, with numerous post-surgical complications and a recent history of disarticulation (removal of the entire leg at the hip), presented with a wound breakdown of her recent surgical site. She was brought to the operating room for debridement. Following the procedure, biopsies of the surgical site were submitted to microbiology. All grew the same organism, Klebsiella pneumoniae. Antimicrobial susceptibility testing was performed and revealed resistance to all drugs in the panel. These results, plus an additional e-test result, helped to reveal the organism’s likely resistance mechanism. 

What do you think is the most likely mechanism of resistance?

Watch the video below for the reveal.

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