From the Guidelines
Klebsiella pneumoniae urinary tract infections (UTIs) should be treated with carbapenems, such as meropenem or imipenem, as targeted therapy, especially in patients with severe infections or septic shock, as recommended by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1. When considering treatment options, it's essential to take into account the severity of the illness, local resistance patterns, and specific host factors, such as allergies.
- For patients with complicated UTIs, including those with underlying urological abnormalities or recent history of instrumentation, treatment should be tailored to the individual case, with a focus on addressing the underlying complicating factor 1.
- The choice of antibiotic should be guided by susceptibility testing, and initial empiric therapy should be adjusted based on culture results.
- In cases of resistance or complicated infections, alternative treatment options, such as piperacillin-tazobactam or ertapenem, may be considered.
- The duration of treatment should be closely related to the treatment of the underlying abnormality, with a general recommendation of 7-14 days, depending on the severity of the infection and the patient's response to treatment 1.
- It's crucial to prioritize antibiotic stewardship and avoid the use of broad-spectrum antibiotics, such as carbapenems, whenever possible, to minimize the risk of resistance development and promote effective treatment outcomes.
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 complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa Levofloxacin tablets are indicated for the treatment of uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus
Levofloxacin (PO) is indicated for the treatment of Urinary Tract Infections (UTIs) caused by Klebsiella pneumoniae, including both complicated and uncomplicated cases 2.
From the Research
UTI with Klebsiella pneumoniae
- Klebsiella pneumoniae is one of the bacteria most frequently causing health care-associated urinary tract infections, and increasingly incriminating Klebsiella pneumoniae carbapenemase producers (KPCp) 3.
- KPCp-UTIs are a real challenge for physicians, with no guidelines currently available for choosing the most appropriate treatment in each specific case 3.
- New antibiotic treatments such as cefiderocol, meropenem-vaborbactam, ceftazidim-avibactam, and imipenem-relebactam represent a major step forward in the treatment of these UTIs 3.
Treatment Options
- Trimethoprim-sulfamethoxazole (TRS) may be a cost-effective long-term solution for patients with multidrug-resistant K. pneumoniae UTIs, with microbiological eradication and symptomatic relief observed in all patients in one study 4.
- Fosfomycin was found to be the most active antimicrobial against K. pneumoniae, with 89% susceptibility 5.
- Piperacillin-tazobactam and aminoglycosides are carbapenem-sparing agents that exhibited higher activity against K. pneumoniae 5.
Antimicrobial Susceptibility
- Low susceptibility (<60%) was observed for standard oral antibiotics prescribed for cystitis, including co-trimoxazole, ciprofloxacin, amoxicillin-clavulanic acid, nitrofurantoin, and cefuroxime 5.
- Extended-spectrum beta-lactamases ranged from 36-61% in India, with significant regional variations in antimicrobial susceptibility across the country 5.
- Male gender and higher age groups were identified as risk factors for resistance to certain antibiotics in K. pneumoniae and other uropathogens 6.