title: Cefepime combined with amoxicillin/clavulanic acid: a new choice for the KPC-producing K. pneumoniae infection.
abstract: OBJECTIVE
  Clinical treatment for blaKPC-positive Klebsiella pneumoniae isolates is challenging because the recommended antibiotic options are limited and are extraordinarily expensive. This study aimed to explore a new therapy for infection caused by KPC-producing K. pneumoniae.
  
  
  METHODS
  Patients with blaKPC-positive K. pneumoniae infection, were prospectively screened and were categorised into two groups: patients in the study group received a combination-based therapy of cefepime and amoxicillin/clavulanic acid and the control group received tigecycline-based therapy. The pathogen clearance rate, 28-day mortality and cost of the antibiotic treatment were compared between the two groups. Moreover, the checkerboard microdilution method was performed to determine the synergy between cefepime and amoxicillin/clavulanic acid in vitro.
  
  
  RESULTS
  Twenty-six and 25 cases were enrolled in the study and control groups. The mortality and the overall pathogen clearance rate showed no significant differences (P=0.311 and P=0.447). Both the total cost and the portion of the cost not covered by insurance were higher for the control group compared to the study group (both P<0.001). Consistently, synergy (65.4%) and partial synergy (26.9%) were the main effects.
  
  
  CONCLUSIONS
  In contrast to the currently recommended tigecycline-based therapy, cefepime and amoxicillin/clavulanic acid combination was an effective and economical option to KPC-KP infection in China.
authors.affiliation: Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China.
authors.forename: Shujuan
authors.initials: S
authors.lastname: Ji
authors.affiliation: Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China.
authors.forename: Fangfang
authors.initials: F
authors.lastname: Lv
authors.affiliation: Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China.
authors.forename: Xiaoxing
authors.initials: X
authors.lastname: Du
authors.affiliation: Key Laboratory of Infectious Diseases of the Public Health Ministry, First Affiliated Hospital, School of Medicine, Zhejiang University, China.
authors.forename: Zeqing
authors.initials: Z
authors.lastname: Wei
authors.affiliation: Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China.
authors.forename: Xinli
authors.initials: X
authors.lastname: Mu
authors.affiliation: Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China; Key Laboratory of Infectious Diseases of the Public Health Ministry, First Affiliated Hospital, School of Medicine, Zhejiang University, China. Electronic address: yvys119@163.com.
authors.forename: Yunsong
authors.initials: Y
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000096:biosynthesis; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000031:analogs & derivatives / Q000627:therapeutic use; D000078304:Tigecycline; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D002511:Cephalosporins; D000078304:Tigecycline; D019980:Amoxicillin-Potassium Clavulanate Combination; D000077723:Cefepime; D001618:beta-Lactamases; C063912:carbapenemase; D008911:Minocycline
keywords: Amoxicillin/clavulanic acid; Cefepime; KPC; Klebsiella pneumoniae; Prospective study; Tigecycline