Use of carbapenems in the combined treatment of emerging ceftazidime/avibactam-resistant and carbapenem-susceptible KPC-producing Klebsiella pneumoniae infections: Report of a case and review of the literature. (September 2020)

• Record Type: Journal Article
• Authors: Cano, Ángela; Guzmán-Puche, Julia; García-Gutiérrez, Manuel; Castón, Juan José; Gracia-Ahufinger, Irene; Pérez-Nadales, Elena; Recio, Manuel; Natera, Alejandra M.; Marfil-Pérez, Eduardo; Martínez-Martínez, Luis; Torre-Cisneros, Julian
• Is Part Of: Journal of global antimicrobial resistance. Volume 22(2020)
• Page Start: 9
• Page End: 12
• Publication Date: 2020-09
• Subjects: Klebsiella pneumoniae -- Carbapenems -- Ceftazidime/avibactam-resistance; Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2019.11.007
• Languages: English
• ISSNs: 2213-7165

Abstract

Highlights: The efficacy of ceftazidime/avibactam can be limited by the development of resistance. Carbapenems are an option to treat infections that are resistant to ceftazidime/avibactam. Mutations in the Ω-loop can result in a decrease in carbapenem MICs. Abstract: Objectives: To describe the case of a patient with infection due to a KPC-producing Klebsiella pneumoniae ( K. pneumoniae ) isolate developing ceftazidime-avibactam resistance with restored carbapenem susceptibility during ceftazidime-avibactam therapy. To review the clinical/microbiological cure and survival rates using carbapenems in other similar case reports and case series. Patients and methods: A patient with an intra-abdominal infection due to K. pneumoniae producing the KPC-48 variant (L169P-A172T) (resistant to ceftazidime/avibactam and susceptible to carbapenems) who was treated with imipenem-cilastatin in combination with tigecycline and gentamicin. The literature was reviewed in order to summarise the in vivo (clinical/microbiological cure and survival rate) use of carbapenems in this emerging scenario. Results: The patient was successfully treated with the indicated regimen. In other reported cases (mostly with pneumonia) all-cause mortality was 50% and clinical cure was 62.5%. Meropenem-vaborbactam has been successful used in an additional case. Conclusions: A carbapenem-based regimen of combination therapy seems to be an option for treating patients infected with K. pneumoniae resistant to ceftazidime/avibactam and susceptible to carbapenems, at least when the risk of mortality is low.