Bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae: a clinical perspective

Expert Rev Anti Infect Ther. 2012 Dec;10(12):1393-404. doi: 10.1586/eri.12.138.

Abstract

Dissemination of carbapenemase-producing Klebsiella pneumoniae (CP-Kp) has caused a public health crisis that can be paralleled with that caused by the spread of MRSA. CP-Kps, being multidrug-resistant, mainly affect patients with severe underlying conditions in the acute-healthcare setting. CP-Kps are responsible for a variety of life-threatening infections including bacteremia and pneumonia. The shortage of therapeutic options has forced clinicians to use colistin as well as tigecycline, a novel bacteriostatic agent. Although both drugs are generally active in vitro against CP-Kps, therapeutic failures, especially in bacteremias, are quite common. The authors suggest here, after reviewing the literature, that use of the latter drugs should be re-assessed and optimized. The authors have also summarized experimental and clinical data indicating that exploitation of the pharmacokinetic/pharmacodynamic features of carbapenems may provide solutions in bloodstream infections caused by CP-Kps with low-level resistance to the latter drugs. Most importantly, there is evidence that monotherapy must be avoided.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / therapeutic use
  • Bacteremia / drug therapy*
  • Bacteremia / microbiology
  • Bacteremia / mortality
  • Bacterial Proteins / biosynthesis*
  • Decision Support Techniques
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Resistance, Bacterial
  • Drug Therapy, Combination
  • Humans
  • Klebsiella Infections / drug therapy*
  • Klebsiella Infections / microbiology
  • Klebsiella Infections / mortality
  • Klebsiella pneumoniae / drug effects*
  • Klebsiella pneumoniae / enzymology
  • beta-Lactamases / biosynthesis*

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • beta-Lactamases
  • carbapenemase-2, Klebsiella pneumoniae
  • oxacillinase