Combination Therapy for High-Level Meropenem- and Colistin-Resistant Klebsiella pneumoniae Bacteremia

In areas with multiple-drug resistant gram-negative pathogens, empiric antimicrobial regimens should be aggressive for severely ill patients with known or suspected sepsis.

Despite recent antimicrobial developments, treating invasive carbapenem-resistant gram-negative infections is challenging. Recent findings suggest that a carbapenem/colistin combination improves survival when the meropenem/imipenem minimum inhibitory concentration is <8 mg/L, but optimal treatment when high-level carbapenem/colistin resistance is present is unclear.

Investigators compared monotherapy with combination therapy for 72 patients with resistant bacteremia. The pathogen was susceptible to all antimicrobials evaluated in both treatment groups. Overall 30-day crude mortality was 25% with combination therapy and 44% with monotherapy. There were significantly more diabetic patients in the monotherapy arm, and more mechanically ventilat…

Reviewing Author

George Sakoulas, MD

Disclosures

Consultant/Advisory BoardParatek Pharmaceuticals; Nestle Corp.; AbbVie; Shionogi

Speaker’s BureauAllergan/AbbVie; Paratek Pharmaceuticals; Nestle Corp.

RoyaltiesUpToDate

Editorial BoardsAntimicrobial Agents and Chemotherapy; Open Forum Infectious Diseases