New advances in management and treatment of multidrug-resistant Klebsiella pneumoniae

ABSTRACT

Introduction

The management of multidrug-resistant (MDR) Klebsiella pneumoniae (KP) represents a major challenge in the field of infectious diseases. It is associated with a high rate of nosocomial infections with a mortality rate that reaches approximately 50%, even when using an effective antimicrobial therapy. Therefore, combined actions addressing infection control and antibiotic stewardship are required to delay the emergence of resistance. Since new antimicrobial agents targeting MDR-GNB bacteria have been produced during the last years and are now available for physicians to treat MDR, it is fundamental to choose appropriate antimicrobial therapy for K. pneumoniae infection.

Areas covered

The PubMed database was searched to review the most significant recent literature on the topic, including data from articles coming from endemic areas and from the current European and American Guidelines.

Expert opinion

We explore the most effective strategies for prevention of MDR-KP spread and the currently available treatment options, focusing on comparing old strategies and new compounds. We reviewed data concerning newly developed drugs that could play an important role in the future; we also propose a treatment algorithm that could be useful for physicians in daily clinical practice.

KEYWORDS:

• multi-drug-resistant-Klebsiella pneumoniae
• infection control
• novel antimicrobials
• antimicrobial stewardship

Article highlights

• MDR-Kp infections represent a major issue for healthcare workers due to its association with hospital outbreaks and high mortality rate.

• Infection control measures, screening of colonized patients and improvement of antimicrobial stewardships strategies to avoid uncontrolled consumption of antibiotics are fundamental tools to avoid spreading of MDR bacteria and contrast the emergence of new resistant strains

• Healthcare workers must be aware of the risk factors associated with the acquisition of these infections to enact preventive measures, with a special focus on fragile patients

• The role of rapid molecular microbiological tests is essential to guide diagnosis and to detect the genes of resistance associated with the MDR-strains to guide physicians in the choice of the best antibiotic regimen available

• New compounds on the market such as ceftazidime/avibactam can be used in monotherapy in case of targeted therapy as the available data show their efficacy when used alone.

• It is important to pay attention to the emergence of resistance to novel drugs, as already experienced with ceftazidime/avibactam, thus molecular microbiological surveillance must be implemented.

• New inhibitors such as zidebactam and nacubactam showed promising results in preliminary studies exhibiting a large spectrum of activity also against MBLs producers. Further results from trial ongoing are required.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or mending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.