What are the appropriate antibiotics for Klebsiella (Klebsiella pneumoniae) infections?

From the Guidelines

For Klebsiella infections, the recommended antibiotics depend on the infection site and antibiotic susceptibility testing, with carbapenems like meropenem or imipenem being first-line treatment options, as suggested by the 2017 WSES guidelines for management of intra-abdominal infections 1.

Key Considerations

• The choice of empiric antibiotic regimens should be based on the clinical condition of the patients, the individual risk for infection by resistant pathogens, and the local resistance epidemiology 1.
• In patients with suspected or proven infection with carbapenemase-producing Klebsiella pneumoniae, consider use of antibiotic combinations with Ceftazidime/Avibactam 1.
• Antibiotic susceptibility testing is crucial for guiding appropriate therapy, as resistance patterns vary geographically and are increasing globally 1.

Treatment Options

• First-line treatment often includes carbapenems like meropenem (1g IV every 8 hours) or imipenem (500mg IV every 6 hours) for 7-14 days.
• For less severe infections, ceftriaxone (1-2g IV daily) or cefepime (2g IV every 12 hours) may be effective.
• In cases of urinary tract infections, fluoroquinolones such as ciprofloxacin (500mg orally twice daily for 7-10 days) might be used if the strain is susceptible.
• For multidrug-resistant Klebsiella, combination therapy with colistin (loading dose of 9 million units, then 4.5 million units IV every 12 hours) plus another agent may be necessary.

Duration of Treatment

• Treatment duration varies based on infection severity and site, typically ranging from 7-14 days.
• Patients who have ongoing signs of peritonitis or systemic illness beyond 5-7 days of antibiotic treatment normally warrant a diagnostic investigation to determine whether additional surgical intervention is necessary to address an ongoing uncontrolled source of infection or antimicrobial treatment failure 1.

From the FDA Drug Label

1. 2 Nosocomial Pneumonia Piperacillin and Tazobactam for Injection is indicated in adults and pediatric patients (2 months of age and older) for the treatment of nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of Staphylococcus aureus and by piperacillin and tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa
2. 1 Complicated Skin and Skin Structure Infections Tigecycline for injection is indicated in patients 18 years of age and older for the treatment of complicated skin and skin structure infections caused by susceptible isolates of Escherichia coli, Enterococcus faecalis (vancomycin-susceptible isolates), Staphylococcus aureus (methicillin-susceptible and -resistant isolates), Streptococcus agalactiae, Streptococcus anginosus grp. (includes S. anginosus, S. intermedius, and S. constellatus), Streptococcus pyogenes, Enterobacter cloacae, Klebsiella pneumoniae, and Bacteroides fragilis.

• Piperacillin-tazobactam and Tigecycline are two antibiotics that can be used to treat infections caused by Klebsiella pneumoniae.
• The dosage of Piperacillin-tazobactam for nosocomial pneumonia is 4.5 grams every six hours plus an aminoglycoside 2.
• The dosage of Tigecycline is an initial dose of 100 mg, followed by 50 mg every 12 hours 3.

From the Research

Antibiotics for Klebsiella

• The treatment of Klebsiella pneumoniae infections is challenging due to the increasing resistance to antibiotics, including carbapenems 4.
• Taniborbactam, a newly developed beta-lactamase inhibitor, has shown promising results in combination with cefepime or meropenem against Klebsiella pneumoniae, including metallo-beta-lactamase-producing strains 5.
• A systematic review and meta-analysis found that combination therapy is associated with lower mortality rates compared to monotherapy in patients with carbapenemase-producing Klebsiella pneumoniae infections 6.
• The MERINO trial is a randomized controlled trial comparing meropenem with piperacillin-tazobactam for the treatment of bloodstream infections caused by ceftriaxone non-susceptible Escherichia coli and Klebsiella spp. 7.
• A review of published case series and case reports found that combination therapy is recommended for the treatment of Klebsiella pneumoniae carbapenemase (KPC) infections, although the optimal combination of antimicrobial agents is still unclear 8.

Treatment Options

• Cefepime-taniborbactam and meropenem-taniborbactam are potential treatment options for infections caused by metallo-beta-lactamase-producing Klebsiella pneumoniae 5.
• Combination therapy with aminoglycosides may be associated with better outcomes compared to aminoglycoside-sparing therapies in patients with carbapenemase-producing Klebsiella pneumoniae infections 6.
• Polymyxin-based combination therapy may be associated with lower treatment failure rates compared to polymyxin monotherapy in patients with KPC infections 8.

Resistance and Epidemiology

• The increasing resistance to antibiotics, including carbapenems, is a major concern in the treatment of Klebsiella pneumoniae infections 4, 6.
• The emergence of metallo-beta-lactamase-producing Klebsiella pneumoniae is a significant public health challenge 5, 8.
• The epidemiology of Klebsiella pneumoniae infections is complex, with both hospital-acquired and community-acquired infections reported 4, 7.