What is the recommended treatment for a urinary tract infection caused by Klebsiella pneumoniae with a colony count of greater than 100,000 CFU/mL?

From the Guidelines

For a urinary tract infection caused by Klebsiella pneumoniae with a colony count greater than 100,000 CFU/mL, the recommended treatment is a carbapenem, such as imipenem or meropenem, as targeted therapy, according to the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1. The choice of antibiotic treatment for Klebsiella pneumoniae infections should be guided by the severity of the infection and the susceptibility pattern of the isolate.

• For patients with low-risk, non-severe infections, piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones may be considered, taking into account antibiotic stewardship principles 1.
• The use of aminoglycosides, such as gentamicin, may be considered for short durations of therapy in patients with complicated urinary tract infections (cUTI) without septic shock 1.
• It is essential to note that the treatment choice should be adjusted based on the susceptibility testing results, and the full course of antibiotics should be completed even if symptoms improve quickly.
• Patients should increase fluid intake during treatment, and urinary pain and burning may be relieved with phenazopyridine (Pyridium) 200 mg three times daily for 2 days.
• If symptoms worsen or don't improve within 48-72 hours, patients should seek medical attention, as this may indicate antibiotic resistance or complications requiring a change in treatment approach. The susceptibility testing results provided show that the Klebsiella pneumoniae isolate is susceptible to several antibiotics, including ciprofloxacin, levofloxacin, and meropenem, which can guide the treatment choice. However, the most recent and highest-quality study recommends a carbapenem as the first-line treatment for Klebsiella pneumoniae infections 1.

From the FDA Drug Label

Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis Levofloxacin tablets are indicated for the treatment of uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus

The recommended treatment for a urinary tract infection caused by Klebsiella pneumoniae with a colony count of greater than 100,000 CFU/mL is levofloxacin 2.

• The MIC for levofloxacin is <=0.12, which indicates that the bacteria is susceptible to this antibiotic.
• The patient should be treated with levofloxacin as indicated in the drug label for uncomplicated or complicated urinary tract infections.

From the Research

Treatment Options for Urinary Tract Infections caused by Klebsiella pneumoniae

The recommended treatment for a urinary tract infection (UTI) caused by Klebsiella pneumoniae with a colony count of greater than 100,000 CFU/mL depends on various factors, including the susceptibility pattern of the isolate and the severity of the infection.

• According to 3, treatment options for UTIs due to ESBL-producing Klebsiella pneumoniae include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin.
• A study published in 4 suggests that high-dose amoxicillin with clavulanic acid may be an effective treatment option for UTIs caused by ESBL-producing Klebsiella pneumoniae.
• Another study 5 reports the successful use of doxycycline in treating a patient with a UTI caused by multidrug-resistant Klebsiella pneumoniae.

Antimicrobial Susceptibility

The antimicrobial susceptibility pattern of the Klebsiella pneumoniae isolate is crucial in guiding treatment decisions.

• The provided test results show that the isolate is susceptible to amoxicillin-clavulanate, amp/sulbactam, cefepime, ceftazidime, ceftriaxone, ciprofloxacin, gentamicin, imipenem, levofloxacin, meropenem, and piperacillin-tazobactam.
• However, the isolate is intermediate to nitrofurantoin and resistant to none of the tested antibiotics, except for the fact that the result for cefazolin is not reported.
• A study published in 6 evaluated the susceptibility of Klebsiella pneumoniae isolates from UTIs to quinolones and found that 86.7% of the isolates were susceptible to gatifloxacin, 76.7% to norfloxacin, and 51.2% to ciprofloxacin.

Considerations for Treatment

When selecting a treatment option, it is essential to consider the potential for resistance development and the effectiveness of the antibiotic against the specific isolate.

• A study published in 7 compared the clinical outcomes of patients receiving ceftriaxone versus levofloxacin for the treatment of acute pyelonephritis and found that ceftriaxone was more effective in terms of microbiological response.
• The use of broad-spectrum antibiotics, such as carbapenems, should be reserved for severe or complicated infections, as recommended in 3.