From the Research
Klebsiella variicola urinary tract infections (UTIs) should be treated with antibiotics such as nitrofurantoin, fosfomycin, or pivmecillinam as first-line options, considering the high rates of resistance to trimethoprim-sulfamethoxazole and ciprofloxacin, as well as the potential for extended-spectrum beta-lactamases (ESBLs) production. The treatment of Klebsiella variicola UTIs requires careful consideration of the antibiotic resistance patterns of the bacteria. According to a study published in 2020 1, the recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis includes a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam.
Key considerations in treating K. variicola UTIs include:
- High rates of resistance to trimethoprim-sulfamethoxazole and ciprofloxacin, which preclude their use as empiric treatment in several communities 1
- Potential for ESBLs production, which may limit treatment options and require the use of carbapenem antibiotics like meropenem 1
- Importance of accurate identification and susceptibility testing to guide effective treatment, as K. variicola was previously misidentified as K. pneumoniae but is now recognized as a distinct species with potentially different antibiotic resistance patterns 2, 3
Treatment options for K. variicola UTIs may include:
- Oral antibiotics such as nitrofurantoin, fosfomycin, or pivmecillinam as first-line options 1
- Parenteral treatment options such as piperacillin-tazobactam, carbapenems, or ceftazidime-avibactam for more severe infections or resistant strains 1
- Alternative options such as amikacin, gentamicin, fosfomycin, or polymyxin B for strains with specific resistance patterns 4
It is essential to prioritize the use of the most recent and highest-quality studies to guide treatment decisions, such as the 2020 study published in Postgraduate Medicine 1, which provides recommendations for the treatment of UTIs caused by antibiotic-resistant Gram-negative bacteria, including K. variicola. Additionally, a 2023 study published in Infection and Drug Resistance 4 highlights the emergence of OXA-484-producing K. variicola in China, emphasizing the need for continued surveillance and adaptation of treatment strategies to address the evolving landscape of antibiotic resistance.