Journal
JOURNAL OF GLOBAL ANTIMICROBIAL RESISTANCE
Volume 22, Issue -, Pages 9-12Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.jgar.2019.11.007
Keywords
Klebsiella pneumoniae; Carbapenems; Ceftazidime/avibactam-resistance
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Funding
- Plan Nacional de I+D+i 2013-2016
- Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Ciencia, Innovacion y Universidades, Spanish Network for Research in Infectious Diseases [RD16/0016/0008]
- European Development Regional Fund 'A way to achieve Europe', Operational ProgrammeSmart Growth 2014-2020
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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. (C) 2019 International Society for Antimicrobial Chemotherapy. Published by Elsevier Ltd.
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