From the Guidelines
Cefepime should not be used as a first-line treatment for Klebsiella urinary tract infections due to concerns about resistance and limited efficacy against certain strains. According to the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1, cefepime is not recommended for the treatment of third-generation cephalosporin-resistant Enterobacterales (3GCephRE) infections, which include Klebsiella species. The guidelines suggest that carbapenems, such as imipenem or meropenem, are preferred for the treatment of severe 3GCephRE infections, while piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones may be considered for low-risk, non-severe infections.
For complicated urinary tract infections (cUTI) caused by Klebsiella species, the guidelines conditionally recommend aminoglycosides or IV fosfomycin as alternative treatment options 1. It is essential to note that antimicrobial susceptibility testing is crucial before initiating therapy to ensure the chosen antibiotic is effective against the specific Klebsiella strain.
Key considerations for treating Klebsiella urinary tract infections include:
- Antimicrobial susceptibility testing to guide antibiotic selection
- Use of carbapenems or alternative antibiotics, such as aminoglycosides or IV fosfomycin, for severe or complicated infections
- Avoidance of cefepime due to concerns about resistance and limited efficacy
- Dose adjustments for patients with renal impairment, if an alternative antibiotic is used
- Monitoring for signs of treatment failure or resistance, and adjusting the antibiotic regimen as needed.
From the FDA Drug Label
1.3 Uncomplicated and Complicated Urinary Tract Infections (including pyelonephritis) Cefepime Injection is indicated for uncomplicated and complicated urinary tract infections (including pyelonephritis) caused by Escherichia coli or Klebsiella pneumoniae, when the infection is severe, or caused by Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis, when the infection is mild to moderate, including cases associated with concurrent bacteremia with these microorganisms.
Cefepime is effective against Klebsiella urinary tract infections. The FDA-approved indications for cefepime include treatment of uncomplicated and complicated urinary tract infections caused by Klebsiella pneumoniae. 2
From the Research
Cefepime Effectiveness Against Klebsiella Urinary Tract Infections
- Cefepime is a fourth-generation cephalosporin with broad-spectrum activity against Gram-negative bacteria, including Klebsiella pneumoniae 3, 4, 5.
- Studies have shown that cefepime is effective against Klebsiella urinary tract infections, with clinical cure rates ranging from 89% to 93% 3, 5.
- Cefepime has been compared to other antibiotics, such as ceftazidime, and has been found to have similar efficacy and safety profiles 3.
- The minimum inhibitory concentrations (MICs) of cefepime against Klebsiella pneumoniae have been found to be low, indicating that cefepime is active against this pathogen 6, 7.
- Cefepime has been used to treat both complicated and uncomplicated urinary tract infections, including those caused by Klebsiella pneumoniae, and has been found to be effective in eradicating the pathogen and resolving symptoms 3, 4, 5.
Spectrum of Activity
- Cefepime has a broad spectrum of activity against Gram-negative bacteria, including Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis 3, 4.
- Cefepime is also active against some Gram-positive bacteria, although its activity against these pathogens is generally lower than that of other cephalosporins 6, 7.
- Cefepime has been found to be effective against a wide range of urinary tract pathogens, including those that are resistant to other antibiotics 3, 5.
Clinical Efficacy
- Cefepime has been found to be clinically effective in the treatment of urinary tract infections, with cure rates ranging from 89% to 93% 3, 5.
- Cefepime has been compared to other antibiotics, such as ceftazidime, and has been found to have similar efficacy and safety profiles 3.
- Cefepime has been used to treat both complicated and uncomplicated urinary tract infections, including those caused by Klebsiella pneumoniae, and has been found to be effective in eradicating the pathogen and resolving symptoms 3, 4, 5.