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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. | LitMetric

AI Article Synopsis

  • A patient with an intra-abdominal infection caused by KPC-producing Klebsiella pneumoniae resistant to ceftazidime-avibactam was successfully treated with a carbapenem-based therapy.
  • The literature review highlighted varying success rates from prior cases, with a 50% mortality rate and a 62.5% clinical cure rate in similar infections.
  • The findings suggest that using a carbapenem combination therapy can be an effective treatment option for such infections when the patient's mortality risk is lower.

Article 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.

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Source
http://dx.doi.org/10.1016/j.jgar.2019.11.007DOI Listing

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