Antibiotics (Abx) for Extended-Spectrum Beta-Lactamase (ESBL) producing Klebsiella pneumoniae Pneumonia

From the Guidelines

Antibiotics for Extended-Spectrum Beta-Lactamase (ESBL) producing Klebsiella pneumoniae Pneumonia should be ceftazidime/avibactam or meropenem/vaborbactam as first-line treatment options.

Rationale

• The use of ceftazidime/avibactam and meropenem/vaborbactam is supported by strong recommendations with moderate certainty of evidence 1.
• These novel β-lactam agents have shown favourable results in observational studies, with higher clinical cure rates and lower mortality compared to traditional antibiotic regimens 1.
• Meropenem/vaborbactam may be considered as the first choice for pneumonia due to its high intrapulmonary penetration ratios and ELF concentrations that remain consistently higher than the MIC90 of KPC-producing K. pneumoniae 1.
• Local epidemiology and resistance patterns should be considered when choosing between ceftazidime/avibactam and meropenem/vaborbactam, as KPC variants that confer resistance to ceftazidime/avibactam have been described 1.
• Imipenem/relebactam and cefiderocol may also be considered as potential alternatives for the treatment of infections involving KPC-producing CRE, although clinical studies of their efficacy are limited 1.

Key Points

• Ceftazidime/avibactam and meropenem/vaborbactam are the recommended first-line treatment options for ESBL-producing Klebsiella pneumoniae pneumonia.
• Meropenem/vaborbactam may be preferred for pneumonia due to its high intrapulmonary penetration ratios.
• Local epidemiology and resistance patterns should guide the choice between ceftazidime/avibactam and meropenem/vaborbactam.
• Imipenem/relebactam and cefiderocol may be considered as alternative treatment options.
• The use of cephalosporins should be discouraged in settings with a high incidence of ESBL-producing Enterobacteriaceae, and should be limited to pathogen-directed therapy 1.

From the Research

Antibiotic Treatment for ESBL-Producing Klebsiella pneumoniae Pneumonia

• The use of carbapenems, such as meropenem, has been shown to be effective against ESBL-producing Klebsiella pneumoniae 2.
• Flomoxef, a beta-lactam antibiotic, may also be effective in treating ESBL-producing Klebsiella pneumoniae, especially in cases where the isolate is susceptible to flomoxef 2.
• However, the rise of antibiotic resistance, including resistance to carbapenems, is a significant concern 3.
• Colistin has been shown to be effective against ESBL-producing Klebsiella pneumoniae, including those resistant to carbapenems 3.

Antibiotic Resistance Patterns

• ESBL-producing Klebsiella pneumoniae often exhibit resistance to multiple antibiotics, including beta-lactams, fluoroquinolones, and aminoglycosides 4, 5.
• The prevalence of ESBL-producing Klebsiella pneumoniae varies by region, but it is a significant concern worldwide 3, 4, 5.
• The use of antimicrobial photodynamic therapy (aPDI) has been shown to be effective against ESBL-producing Klebsiella pneumoniae, including those resistant to carbapenems 6.

Synergistic Effects of Antibiotics

• The combination of aPDI with beta-lactam antibiotics, such as imipenem and cefotaxime, has been shown to have a synergistic effect against ESBL-producing Klebsiella pneumoniae 6.
• The use of combination therapy may be an effective way to combat antibiotic resistance and improve treatment outcomes 6.