NDM-Producing Multidrug-Resistant Klebsiella pneumoniae in a Secondary-Level Hospital: A Critical Threshold in a Resource-Limited Setting

Resumen

This case report describes the clinical course of a 52-year-old patient with multiple comorbidities admitted to the intensive care unit due to acute respiratory distress. Despite initial supportive management, the patient developed progressive clinical deterioration during a prolonged ICU stay, with subsequent suspicion of a healthcare-associated lower respiratory tract infection. After 21 days of hospitalization, bronchoscopy with bronchoalveolar lavage was performed, and microbiological culture identified multidrug-resistant Klebsiella pneumoniae. In a resource-limited setting, the diagnostic process was further supported by privately funded multiplex testing arranged by the patient’s relatives, which helped clarify the microbiological profile and reinforced therapeutic decision-making. This case illustrates the complex interaction between critical illness, prolonged ICU exposure, invasive procedures, and the emergence of highly resistant pathogens, including NDM-associated resistance patterns, in secondary-level hospitals with limited diagnostic capacity. It also highlights the clinical value of bronchoscopy and bronchoalveolar lavage in targeted etiological assessment when conventional approaches are insufficient. The case underscores the growing threat posed by multidrug-resistant gram-negative infections in critical care and the urgent need to strengthen local microbiological support, antimicrobial stewardship, and early diagnostic strategies in resource-constrained institutions.