Klebsiella pneumoniae Sensitivity to Rocephin (Ceftriaxone)
Klebsiella pneumoniae generally shows high resistance to ceftriaxone (Rocephin), with resistance rates reported as high as 98.2% in recent studies. 1
Resistance Patterns of Klebsiella pneumoniae
- According to recent research, K. pneumoniae isolates display very high resistance to ceftriaxone, with studies showing resistance rates of 98.2% 1
- K. pneumoniae can acquire resistance to cephalosporins and aztreonam through production of extended-spectrum β-lactamases (ESBLs) 2
- Plasmids encoding ESBLs often carry resistance to multiple antibiotics, making K. pneumoniae frequently multidrug-resistant 2
- While some ESBL-producing strains remain susceptible to carbapenems, resistance to carbapenems is increasing due to production of carbapenemases 2
Mechanism of Resistance
- K. pneumoniae has several mechanisms to develop resistance to ceftriaxone and other cephalosporins:
- Production of extended-spectrum β-lactamases (ESBLs) that hydrolyze the β-lactam ring 2
- Plasmid-mediated AmpC-type enzymes that confer resistance to cephalosporins 2
- Efflux pump systems (particularly acrAB and tolC) that actively pump antibiotics out of bacterial cells 1
- Altered outer membrane permeability through changes in porin channels (ompK35 and ompK36) 1
Clinical Implications
- The FDA-approved label for ceftriaxone lists K. pneumoniae as a susceptible organism for certain indications including lower respiratory tract infections, skin infections, urinary tract infections, and septicemia 3
- However, this susceptibility information may be outdated as recent studies show high resistance rates 1
- There is a positive correlation between ceftriaxone consumption and increased resistance in K. pneumoniae isolates 4
- For infections caused by K. pneumoniae, susceptibility testing should always be performed before initiating treatment with ceftriaxone 3
Treatment Recommendations for K. pneumoniae Infections
- For suspected or confirmed ESBL-producing K. pneumoniae, carbapenems remain the treatment of choice for susceptible strains 5
- For carbapenem-resistant strains, newer β-lactam/β-lactamase inhibitor combinations such as ceftazidime/avibactam or meropenem/vaborbactam are recommended as first-line options 5
- Cefazolin may be considered as a ceftriaxone-sparing alternative for treating antibiotic-susceptible K. pneumoniae bacteremia 6
- Local antibiotic resistance patterns should guide empiric therapy choices 5
Pitfalls and Caveats
- Never assume ceftriaxone will be effective against K. pneumoniae without susceptibility testing 3, 1
- Resistance rates vary geographically, so local antibiogram data should be consulted 2
- Even if in vitro testing shows susceptibility to ceftriaxone, clinical failure may occur due to inducible resistance mechanisms 2
- The high prevalence of ESBL-producing K. pneumoniae strains limits the utility of ceftriaxone in many clinical settings 1
- Overuse of ceftriaxone contributes to selection pressure and increasing resistance rates 4
In summary, while ceftriaxone is FDA-approved for treating K. pneumoniae infections, current evidence shows high resistance rates that severely limit its clinical utility. Treatment decisions should always be guided by local resistance patterns and individual susceptibility testing.