From the Guidelines
Klebsiella oxytoca infections should be treated with carbapenems, such as meropenem 1g IV every 8 hours, due to the high risk of antibiotic resistance, including production of extended-spectrum beta-lactamases (ESBLs) 1.
Treatment Considerations
When treating K. oxytoca infections, it is essential to consider the potential for antibiotic resistance. The use of third-generation cephalosporins, such as ceftriaxone, and fluoroquinolones, such as ciprofloxacin, may not be effective against ESBL-producing strains 1.
- Carbapenems, such as meropenem, are often the treatment of choice for ESBL-producing K. oxytoca infections.
- Antibiotic susceptibility testing is crucial to guide appropriate therapy and ensure the best possible outcomes.
- Infection control measures, including hand hygiene and contact precautions, are vital to prevent the spread of this organism in healthcare settings.
Antibiotic Resistance
K. oxytoca can develop antibiotic resistance, including production of ESBLs, which complicates treatment 1.
- The use of carbapenems, such as ertapenem, may not be effective against all ESBL-producing K. oxytoca isolates, with an additional 12% of isolates not susceptible to ertapenem when using new MIC interpretive breakpoints 1.
- The clinical efficacy of carbapenems for the treatment of infections caused by isolates with intermediate MICs or disk diffusion test results remains uncertain due to the lack of controlled clinical studies 1.
Infection Control
Infection control measures are essential to prevent the spread of K. oxytoca in healthcare settings 1.
- Hand hygiene and contact precautions are critical to prevent the transmission of this organism.
- Routine reporting of ESBL isolates and appropriate antibiotic therapy are also vital to prevent the spread of antibiotic-resistant strains.
From the Research
Overview of Klebsiella oxytoca
- Klebsiella oxytoca is an emerging pathogen that can cause hospital-acquired infections in adults, with multiple drug resistance to commonly used antibiotics 2.
- It is part of the Klebsiella oxytoca complex, which includes nine species, and can be identified through genome-based analysis 3.
Antimicrobial Resistance
- Klebsiella oxytoca isolates have shown resistance to various antibiotics, including imipenem, meropenem, gentamicin, amikacin, and ceftriaxone 2.
- The rates of nonsusceptibility to carbapenems, ceftriaxone, ciprofloxacin, colistin, and tigecycline among K. oxytoca clinical isolates were 1.8%, 12.5%, 7.1%, 0.8%, and 0.1%, respectively 3.
- Resistance to carbapenems is increasing alarmingly, with the blaKPC-2 gene being the most common carbapenemase gene found in the K. oxytoca complex 3.
Treatment Options
- Ceftazidime-avibactam and colistin are potential treatment options for K. oxytoca infections, although the use of meropenem-containing combination therapies is not recommended for meropenem-resistant isolates 4.
- Aztreonam-avibactam and cefiderocol may also be effective against K. oxytoca, particularly for NDM-producing isolates 4.
- Carbapenem-sparing regimens, such as piperacillin-tazobactam and cefepime, may be used in certain cases, but their effectiveness is limited by the increasing prevalence of ESBL and AmpC-producing isolates 5.
Virulence and Epidemiology
- The K. oxytoca complex is a human commensal that can cause various infections, including antibiotic-associated hemorrhagic colitis, urinary tract infection, and bacteremia 3.
- The production of cytotoxins, such as tilivalline and tilimycin, can lead to antibiotic-associated hemorrhagic colitis, while other virulence factors, such as capsular polysaccharides and fimbriae, may also contribute to pathogenicity 3.