Klebsiella species infection?

From the Guidelines

For patients with Klebsiella species infection, particularly those with extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae, the use of ceftazidime/avibactam is recommended due to its consistent activity against Klebsiella pneumoniae carbapenemases (KPCs) producers, as stated in the 2017 WSES guidelines for management of intra-abdominal infections 1.

Key Considerations

• The management of intra-abdominal infections (IAIs) requires consideration of the patient's clinical condition, individual risk for infection by resistant pathogens, and local resistance epidemiology 1.
• The increasing prevalence of ESBL-producing Enterobacteriaceae and the emergence of carbapenem-resistant Klebsiella pneumoniae pose significant challenges in the treatment of IAIs 1.
• The use of cephalosporins should be discouraged in settings with a high incidence of ESBL-producing Enterobacteriaceae, and should be limited to pathogen-directed therapy to minimize selective pressure and the emergence of resistance 1.

Treatment Options

• Ceftazidime/avibactam and ceftolozane/tazobactam are new cephalosporins/beta-lactamase inhibitor combinations that have shown activity against Gram-negative multidrug-resistant organisms (MDROs), including ESBL-producing Enterobacteriaceae 1.
• These antibiotics should be combined with metronidazole for complicated IAIs due to limited activity against some Bacteroides spp. 1.
• The use of carbapenems should be limited to preserve their activity, and alternative options such as ceftazidime/avibactam and ceftolozane/tazobactam should be considered for the treatment of infections caused by MDROs 1.

Conclusion is not allowed, so the answer will be ended here.

From the FDA Drug Label

Ciprofloxacin Injection, USP is indicated for the treatment of infections caused by susceptible strains of the designated microorganisms in the conditions and patient populations listed below when the intravenous administration offers a route of administration advantageous to the patient. Adult Patients: Urinary Tract Infections caused by Escherichia coli (including cases with secondary bacteremia), Klebsiella pneumoniae subspecies pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, Morganella morganii, Citrobacter diversus, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus epidermidis, Staphylococcus saprophyticus, or Enterococcus faecalis. Ceftriaxone for Injection is indicated for the treatment of the following infections when caused by susceptible organisms: LOWER RESPIRATORY TRACT INFECTIONS Caused by Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes, Proteus mirabilis or Serratia marcescens SKIN AND SKIN STRUCTURE INFECTIONS Caused by Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Viridans group streptococci, Escherichia coli, Enterobacter cloacae, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Morganella morganii,1Pseudomonas aeruginosa, Serratia marcescens, Acinetobacter calcoaceticus, Bacteroides fragilis1or Peptostreptococcus species

Klebsiella species infection can be treated with:

• Ciprofloxacin (IV), as it is indicated for the treatment of infections caused by susceptible strains of Klebsiella pneumoniae subspecies pneumoniae 2
• Ceftriaxone (IV), as it is indicated for the treatment of infections caused by susceptible organisms, including Klebsiella pneumoniae 3

From the Research

Characteristics of Klebsiella Species Infection

• Klebsiella species cause a wide range of diseases including pneumonia, urinary tract infections (UTIs), bloodstream infections, and sepsis 4.
• These infections are particularly a problem among neonates, elderly, and immunocompromised individuals 4.
• Klebsiella is also responsible for a significant number of community-acquired infections 4.

Antibiotic Resistance and Treatment

• The increasing isolation of multidrug-resistant strains has significantly narrowed, or in some settings completely removed, the therapeutic options for the treatment of Klebsiella infections 4.
• Gentamicin is the drug of choice for treatment of a urinary tract infection due to Klebsiella 5.
• Klebsiella species sensitivity to nalidixic acid and cefotaxime was 70-85%; to amikacin, cefotaxime, co-trimoxazole, and gentamicin 60-80% 6.

Virulence and Biofilm Formation

• Klebsiella pneumoniae is an important gram-negative opportunistic pathogen that causes a variety of infectious diseases, including urinary tract infections, bacteremia, pneumonia, and liver abscesses 7.
• The detailed mechanisms of virulence and antibiotic resistance in K. pneumoniae are still not very clear 7.
• Studying and elucidating the pathogenic mechanisms and drug resistance mechanism of K. pneumoniae infection are important parts of current medical research 7.

Genotypic Characterization and Misidentification

• Bacterial whole-genome sequencing (WGS) enables precise species identification and characterization that other technologies do not allow 8.
• A high proportion of the isolates within the K. pneumoniae complex were predicted to be genotypically multidrug-resistant (MDR; 79/84,94.0%) in contrast to K. oxytoca (3/16,18.8%) and Klebsiella michiganensis (0/4,0.0%) 8.
• Multi-locus sequence typing (MLST) revealed a high diversity of sequence types among the Klebsiella spp. with ST14 (10.0%) and ST5429 (10.0%) as the most prevalent ones for K. pneumoniae 8.