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

• Main Authors: Ángela Cano, Julia Guzmán-Puche, Manuel García-Gutiérrez, Juan José Castón, Irene Gracia-Ahufinger, Elena Pérez-Nadales, Manuel Recio, Alejandra M. Natera, Eduardo Marfil-Pérez, Luis Martínez-Martínez, Julian Torre-Cisneros
• Format: Article
• Language: English
• Published: Elsevier 2020-09-01
• Series: Journal of Global Antimicrobial Resistance
• Subjects: Klebsiella pneumoniae; Carbapenems; Ceftazidime/avibactam-resistance
• Online Access: http://www.sciencedirect.com/science/article/pii/S2213716519302991
• ISSN: 2213-7165

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.