From the Guidelines
For treating multi-drug resistant (MDR) Klebsiella in the sputum of a chronic kidney disease (CKD) patient, I strongly recommend using ceftazidime/avibactam as the first-line treatment option, considering its favorable results in observational studies and lower risk of nephrotoxicity compared to other agents 1. When choosing an antibiotic regimen, it is crucial to consider the patient's renal function and adjust the dosage accordingly to minimize the risk of nephrotoxicity.
- Ceftazidime/avibactam has been shown to be effective in treating KPC-producing CRE infections, with a higher clinical cure rate and lower mortality compared to traditional antibiotic regimens 1.
- The dosage of ceftazidime/avibactam should be adjusted based on the patient's renal function, with a recommended dose of 2.5g every 8 hours for patients with normal renal function, and dose adjustments made for patients with impaired renal function.
- Meropenem/vaborbactam may also be considered as an alternative option, especially for patients with pneumonia, due to its high intrapulmonary penetration ratios and ELF concentrations that remain consistently higher than the MIC90 of KPC-producing K. pneumoniae 1.
- Imipenem/relebactam and cefiderocol may be considered as potential alternatives, but their use should be guided by susceptibility testing and local epidemiology, as clinical studies on their efficacy in KPC-producing CRE infections are limited 1.
- It is essential to monitor renal function closely during treatment and adjust the antibiotic regimen as needed to minimize the risk of nephrotoxicity and ensure optimal outcomes for the patient.
- The treatment duration should be individualized based on the patient's clinical response, with a typical duration of 7-14 days.
- Susceptibility testing should be performed to guide the choice of antibiotics, as MDR Klebsiella often requires combination therapy to overcome resistance mechanisms.
From the FDA Drug Label
The microbiological cure rate for Klebsiella pneumoniae was 33/44 (75.0%) in the AVYCAZ arm Microbiological cure rates by pathogen are presented in Table 19. Aerobic Gram-negative group or pathogenAVYCAZa n/N (%)Doripenemb n/N (%) Klebsiella pneumoniae33/44 (75.0)35/56 (62.5)
The recommended treatment for sputum Klebsiella MDR in a CKD patient is AVYCAZ 2.5 grams (ceftazidime 2 grams and avibactam 0.5 grams) IV every 8 hours.
- Microbiological cure rate: 75.0% for Klebsiella pneumoniae
- Dosing: 5 grams intravenously every 8 hours for 10 to 14 days of total therapy 2
From the Research
Treatment Options for Sputum Klebsiella MDR in CKD Patient
- The treatment of multidrug-resistant (MDR) Klebsiella pneumoniae in patients with chronic kidney disease (CKD) is challenging due to limited therapeutic options 3, 4, 5, 6, 7.
- Promising drugs for the treatment of MDR Klebsiella pneumoniae include cefiderocol, aztreonam, ceftazidime/avibactam, and meropenem/vaborbactam 3, 4, 5, 6, 7.
- Ceftazidime/avibactam has been shown to be effective in treating KPC-positive Klebsiella pneumoniae infections, including in patients with CKD 4, 5, 6.
- Meropenem/vaborbactam is also a viable option for the treatment of MDR Klebsiella pneumoniae, particularly in cases where ceftazidime/avibactam is not effective 5, 6, 7.
- Fosfomycin, either alone or in combination with other antibiotics, may be considered as a treatment option for MDR Klebsiella pneumoniae infections, including in patients with CKD 5, 6, 7.
- Combination therapy, such as ceftazidime/avibactam with meropenem or aztreonam, may be effective in treating MDR Klebsiella pneumoniae infections, including in patients with CKD 6.
Considerations for CKD Patients
- CKD patients may require dose adjustments for certain antibiotics, such as meropenem/vaborbactam, to avoid nephrotoxicity 5, 7.
- The choice of antibiotic therapy should be guided by susceptibility testing and clinical experience, taking into account the patient's underlying kidney function and other comorbidities 3, 4, 5, 6, 7.