From the Guidelines
The first-line treatment for Klebsiella infections, specifically those caused by KPC-producing carbapenem-resistant Enterobacterales (CRE), should be novel β-lactam agents such as ceftazidime/avibactam or meropenem/vaborbactam. This recommendation is based on the strongest and most recent evidence from the Italian Society of Infection and Tropical Diseases guideline endorsed in 2022 1. The use of these agents has been shown to improve clinical outcomes in patients with CRE infections, with a significant reduction in mortality and improved clinical cure rates compared to traditional antibiotic regimens.
Key considerations for the treatment of Klebsiella infections include:
- The site of infection, with meropenem/vaborbactam potentially being preferred for infections such as pneumonia due to its pharmacokinetic/pharmacodynamic properties 1
- Local epidemiology and the emergence of resistance to ceftazidime/avibactam, which may necessitate the use of alternative agents such as meropenem/vaborbactam 1
- The importance of antimicrobial susceptibility testing to guide treatment decisions, particularly in the presence of increasing resistance patterns 1
Alternative treatment options, such as imipenem/relebactam and cefiderocol, may also be considered, although clinical studies on their efficacy in patients with KPC-producing CRE infections are limited 1. Ultimately, the choice of treatment should be individualized based on the specific patient and infection characteristics, as well as the availability of antimicrobial susceptibility testing results.
From the FDA Drug Label
1 INDICATIONS AND USAGE
- 2 Complicated Intra-abdominal Infections (Adult and Pediatric Patients) Meropenem for injection is indicated for the treatment of complicated appendicitis and peritonitis caused by ... Klebsiella pneumoniae, ...
The first line treatment for Klebsiella infections, specifically complicated intra-abdominal infections, is meropenem 2.
- Meropenem is indicated for the treatment of complicated intra-abdominal infections caused by Klebsiella pneumoniae.
- It is essential to note that the choice of antibiotic should be based on culture and susceptibility information when available.
- In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
From the Research
First Line Treatment for Klebsiella
- The first line treatment for Klebsiella, specifically carbapenem-resistant Klebsiella pneumoniae (CRKP), is often challenging due to rising resistance to polymyxins 3.
- Combination therapy is recommended instead of monotherapy in CRKP-infected patients, but the best combination for each infection type remains unclear 4.
- Studies have shown that combinations such as meropenem-colistin and imipenem-tigecycline exhibit synergy against CRKP isolates, with imipenem-tigecycline being the most effective combination 3.
- Other studies suggest that treatment with beta-lactam/beta-lactamase inhibitor combinations and fluoroquinolones may increase the risk of ESBL-CRKP infection, highlighting the need for careful consideration of antibiotic use 5.
- The use of combination regimens, including extended-spectrum beta-lactam antibiotics, has been associated with decreased mortality in patients with CRKP bloodstream infections, but the optimal treatment regimen remains unclear 6.
Antibiotic Resistance and Treatment Implications
- Klebsiella spp. are intrinsically resistant to penicillins and can acquire resistance to third- and fourth-generation cephalosporins due to the production of plasmid-mediated extended-spectrum beta-lactamases (ESBLs) 7.
- Most isolates of Klebsiella spp. are susceptible to fluoroquinolones, trimethoprimsulfamethoxazole, aminoglycosides, and carbapenems, but resistance rates are increasing 7.
- Treatment of severe infections caused by Klebsiella spp. may benefit from the combination of beta-lactams (or fluoroquinolones) with aminoglycosides, but the risk of developing resistance during treatment must be carefully monitored 7.