From the Guidelines
For treating Klebsiella infections with both fluoroquinolone and beta-lactamase resistance, ceftazidime/avibactam or meropenem/vaborbactam should be considered as the first-line treatment options. These novel β-lactam agents have shown promising results in treating infections caused by multidrug-resistant bacteria, including KPC-producing carbapenem-resistant Enterobacterales (CRE) [ 1 ].
Key Considerations
- The choice between ceftazidime/avibactam and meropenem/vaborbactam should be based on the site of infection, local epidemiology, and the emergence of resistance [ 1 ].
- Meropenem/vaborbactam may be considered as the first choice in specific types of infections, such as pneumonia, due to its high epithelial lining fluid (ELF) concentrations [ 1 ].
- Imipenem/relebactam and cefiderocol may also be considered as potential alternatives for the treatment of infections involving KPC-producing CRE, although clinical studies of their efficacy in these patients are limited [ 1 ].
Treatment Approach
- Ceftazidime/avibactam or meropenem/vaborbactam should be used as the primary treatment option, with the dosage and duration of treatment depending on the severity and site of infection.
- Susceptibility testing is crucial to guide therapy, as resistance patterns vary.
- Infection control measures, including contact precautions, hand hygiene, and environmental cleaning, are essential to prevent the spread of multidrug-resistant Klebsiella infections.
Important Notes
- The introduction of new antibiotics has changed the therapeutic approach to these infections and improved clinical outcomes in patients with CRE infections [ 1 ].
- Traditional antibiotic regimens, including combinations of carbapenems, aminoglycosides, and colistin, have been associated with poor efficacy and unfavorable toxicity profiles [ 1 ].
From the Research
Treatment Options for Klebsiella with Fluoroquinolone Resistance and Beta Lactamase Resistance
- Combination therapy with aztreonam, ceftazidime/avibactam, and colistin can be effective in treating carbapenemase-producing Klebsiella pneumoniae, as seen in a case report 2.
- The combination of ceftazidime/avibactam and aztreonam may be a viable treatment option for patients with infections caused by metallo-beta-lactamase (MBL)-producing Enterobacteriaceae 2.
- Restricting the use of third-generation cephalosporins and fluoroquinolones may help decrease the incidence and resistance rates of extended-spectrum β-lactamases (ESBL) Klebsiella pneumoniae 3.
- Ceftazidime-avibactam is a potential treatment option for OXA-48-like producers, while colistin remains a second-line option if in vitro susceptibility is demonstrated 4.
- For NDM producers, ceftazidime-avibactam and aztreonam combination or cefiderocol can be used, where available, although higher cefiderocol MICs against NDM producers is a concern 4.
Mechanisms of Resistance
- Klebsiella pneumoniae has developed mechanisms of resistance to different antimicrobials, including β-lactam antibiotics and fluoroquinolones 5.
- The constant selective pressure of multiple antibiotics in hospital settings leads to additional mutations and the development of resistance in K. pneumoniae 5.
Emerging Threats
- The emergence of hypervirulent strains and multidrug-resistant clones of Klebsiella pneumoniae has resulted in increased morbidity and mortality, making it a critical anti-microbial resistance threat 6.
- The high variability of capsule polysaccharide in K. pneumoniae makes it challenging to develop a universal treatment or prevention strategy 6.