From the Guidelines
The treatment for Klebsiella pneumoniae (KPC) infection should be either ceftazidime/avibactam or meropenem/vaborbactam as the first-line treatment options, as recommended by the Italian Society of Infection and Tropical Diseases 1. The choice between these two novel β-lactam agents depends on the site of infection, with meropenem/vaborbactam potentially being preferred for infections such as pneumonia due to its high epithelial lining fluid (ELF) concentrations 1. Key considerations for treatment include:
- The strength of recommendation for ceftazidime/avibactam and meropenem/vaborbactam is strong, with a moderate certainty of evidence 1.
- Imipenem/relebactam and cefiderocol may also be considered as potential alternatives, although clinical studies on their efficacy in KPC-producing CRE infections are limited 1.
- Local epidemiology and the emergence of resistance to ceftazidime/avibactam should be taken into account when selecting a treatment option 1.
- The treatment approach should prioritize reducing morbidity, mortality, and improving quality of life, with a focus on achieving high clinical cure rates and minimizing nephrotoxicity 1.
From the FDA Drug Label
The vaborbactam component of VABOMERE is a non-suicidal beta-lactamase inhibitor that protects meropenem from degradation by certain serine beta-lactamases such as Klebsiella pneumoniae carbapenemase (KPC). VABOMERE demonstrated in vitro activity against Enterobacteriaceae in the presence of some beta-lactamases and extended-spectrum beta-lactamases (ESBLs) of the following groups: KPC, SME, TEM, SHV, CTX-M, CMY, and ACT. VABOMERE has been shown to be active against most isolates of the following bacteria, both in vitro and in clinical infections: Gram-negative bacteria: Enterobacter cloacae species complex, Escherichia coli, Klebsiella pneumoniae.
The treatment for Klebsiella pneumoniae (KPC) infection is VABOMERE (meropenem and vaborbactam), as it has been shown to be active against KPC-producing Enterobacteriaceae 2.
- Key points:
- VABOMERE is a combination of meropenem and vaborbactam.
- Vaborbactam protects meropenem from degradation by KPC.
- VABOMERE has demonstrated in vitro activity against KPC-producing Enterobacteriaceae.
From the Research
Treatment Options for KPC Infection
The treatment of Klebsiella pneumoniae (KPC) infection is challenging due to its resistance to multiple antibiotics. Several studies have investigated the effectiveness of different treatment options, including:
- Combination therapy with ceftazidime/avibactam and another agent, such as a carbapenem or amikacin, which has shown synergy in vitro and improved survival in vivo 3
- Use of carbapenems, such as meropenem, in combination with other agents, such as fosfomycin or tigecycline, which has been successful in treating patients with KPC infections 4, 5, 6
- High-dose continuous infusion of meropenem plus fosfomycin, guided by real-time therapeutic drug monitoring, which has been used to successfully treat a patient with bacteremia and ventilator-associated pneumonia caused by a KPC/OXA-48-like Klebsiella pneumoniae co-producer 6
- Maximization of antibiotic dose and use in combination, which may involve the use of tigecycline and polymyxins, which are often active against KPC-producing organisms in vitro 7
Considerations for Treatment
When treating KPC infections, several factors should be considered, including:
- The susceptibility of the isolate to different antibiotics, which can guide the choice of treatment
- The use of combination therapy, which may be necessary to achieve synergy and improve outcomes
- The potential for the development of resistance to carbapenems, which can limit treatment options
- The importance of real-time therapeutic drug monitoring, which can help guide the use of high-dose antibiotics and minimize the risk of toxicity
Emerging Therapeutic Options
Several emerging therapeutic options are being investigated for the treatment of KPC infections, including: