title: Bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae: a clinical perspective.
abstract: Dissemination of carbapenemase-producing Klebsiella pneumoniae (CP-Kp) has caused a public health crisis that can be paralleled with that caused by the spread of MRSA. CP-Kps, being multidrug-resistant, mainly affect patients with severe underlying conditions in the acute-healthcare setting. CP-Kps are responsible for a variety of life-threatening infections including bacteremia and pneumonia. The shortage of therapeutic options has forced clinicians to use colistin as well as tigecycline, a novel bacteriostatic agent. Although both drugs are generally active in vitro against CP-Kps, therapeutic failures, especially in bacteremias, are quite common. The authors suggest here, after reviewing the literature, that use of the latter drugs should be re-assessed and optimized. The authors have also summarized experimental and clinical data indicating that exploitation of the pharmacokinetic/pharmacodynamic features of carbapenems may provide solutions in bloodstream infections caused by CP-Kps with low-level resistance to the latter drugs. Most importantly, there is evidence that monotherapy must be avoided.
authors.affiliation: First Department of Propaedeutic Medicine, University of Athens, Athens, Greece. gldaikos@gmail.com
authors.forename: George L
authors.initials: GL
authors.lastname: Daikos
authors.forename: Antonis
authors.initials: A
authors.lastname: Markogiannakis
authors.forename: Maria
authors.initials: M
authors.lastname: Souli
authors.forename: Leonidas S
authors.initials: LS
authors.lastname: Tzouvelekis
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D001426:Bacterial Proteins / Q000096:biosynthesis*; D003661:Decision Support Techniques; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C531581:carbapenemase-2, Klebsiella pneumoniae; C108449:oxacillinase