What is the recommended treatment for Klebsiella bacteremia?

From the Guidelines

The recommended treatment for Klebsiella bacteremia is Ceftazidime/avibactam 2.5 g IV q8h, Meropenem/vaborbactam 4 g IV q8h, or Imipenem/cilastatin/relebactam 1.25 g IV q6h, with a treatment duration of 7-14 days. According to the most recent guidelines 1, the choice of treatment should be based on the susceptibility test results, and combination antimicrobial therapy may be necessary in clinically unstable patients. Key considerations for treatment include:

• The use of carbapenem-resistant Enterobacterales (CRE) treatment options, such as Ceftazidime/avibactam or Meropenem/vaborbactam, for bloodstream infections 1
• The potential need for extended-infusion of meropenem for 3 hours if the meropenem MIC is ≥ 8 mg/L 1
• The importance of individualizing treatment duration based on infection site, source control, underlying comorbidities, and initial response to therapy 1
• The consideration of polymyxin-based combinations, such as colistin and tigecycline, for clinically unstable patients 1. It is essential to note that the treatment of Klebsiella bacteremia should be guided by the most recent and highest-quality evidence, and susceptibility testing should be performed to optimize therapy and improve outcomes 1.

From the FDA Drug Label

Table 16. Clinical Cure Rates at TOC by Baseline Pathogen from the Phase 3 cIAI Trial, mMITT Population Aerobic Gram-negative group or pathogenAVYCAZ plus metronidazolea n/N (%)Meropenemb n/N (%) ... Klebsiella pneumoniae40/51 (78.4)37/49 (75. 5)

The recommended treatment for Klebsiella bacteremia is AVYCAZ (ceftazidime and avibactam) plus metronidazole, with a clinical cure rate of 78.4% in the mMITT population 2.

• Key points:
  • The clinical cure rate for Klebsiella pneumoniae was 78.4% with AVYCAZ plus metronidazole.
  • The study compared AVYCAZ plus metronidazole to meropenem in patients with complicated intra-abdominal infections (cIAI).
  • The results suggest that AVYCAZ plus metronidazole is a viable treatment option for Klebsiella bacteremia.

From the Research

Treatment Options for Klebsiella Bacteremia

The treatment of Klebsiella bacteremia depends on various factors, including the severity of the infection, the patient's underlying health conditions, and the antibiotic resistance pattern of the bacteria.

• Combination therapy with a beta-lactam and an aminoglycoside agent is preferred for severely ill patients who experience hypotension 3.
• Ceftazidime-avibactam has been shown to be effective against carbapenem-resistant Klebsiella pneumoniae bacteremia, with higher rates of clinical success and survival compared to other regimens 4.
• The use of carbapenems in combination with other antibiotics, such as tigecycline and gentamicin, may be an option for treating patients infected with K. pneumoniae resistant to ceftazidime/avibactam and susceptible to carbapenems 5.

Antibiotic Resistance and Treatment Outcomes

The emergence of antibiotic-resistant Klebsiella pneumoniae strains has made treatment challenging.

• Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections are associated with high mortality rates, particularly in patients with haematological malignancies 6.
• The use of ceftazidime-avibactam has been shown to be effective against CRKP infections, but the development of resistance to this antibiotic is a concern 7, 5.
• Initial adequate antibiotic therapy is critical to improve survival in patients with CRKP bacteremia 6.

Special Considerations

Certain patient populations, such as those with haematological malignancies, are at higher risk of developing CRKP infections and experiencing poor outcomes.

• The identification of CRKP carriers is critical to prevent the spread of these bacteria 6.
• Timely empiric antibiotic combinations active against CRKP may be suggested as treatment of febrile neutropenia in high-risk patients 6.