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Review
. 2022 Aug 27;11(9):1160.
doi: 10.3390/antibiotics11091160.

Current Positioning against Severe Infections Due to Klebsiella pneumoniae in Hospitalized Adults

Pablo Vidal-Cortés  1 , Ignacio Martin-Loeches  2 , Alejandro Rodríguez  3   4   5   6 , Germán Bou  7   8 , Rafael Cantón  8   9 , Emili Diaz  6   10   11 , Carmen De la Fuente  12 , Julián Torre-Cisneros  8   13   14 , Francisco Xavier Nuvials  15 , Miguel Salavert  16 , Gerardo Aguilar  17   18 , Mercedes Nieto  19 , Paula Ramírez  20 , Marcio Borges  21   22 , Cruz Soriano  23 , Ricard Ferrer  15 , Emilio Maseda  22   24 , Rafael Zaragoza  22   25
Affiliations
Review

Current Positioning against Severe Infections Due to Klebsiella pneumoniae in Hospitalized Adults

Pablo Vidal-Cortés et al. Antibiotics (Basel). .

Abstract

Infections due to Klebsiella pneumoniae have been increasing in intensive care units (ICUs) in the last decade. Such infections pose a serious problem, especially when antimicrobial resistance is present. We created a task force of experts, including specialists in intensive care medicine, anaesthesia, microbiology and infectious diseases, selected on the basis of their varied experience in the field of nosocomial infections, who conducted a comprehensive review of the recently published literature on the management of carbapenemase-producing Enterobacterales (CPE) infections in the intensive care setting from 2012 to 2022 to summarize the best available treatment. The group established priorities regarding management, based on both the risk of developing infections caused by K. pneumoniae and the risk of poor outcome. Moreover, we reviewed and updated the most important clinical entities and the new antibiotic treatments recently developed. After analysis of the priorities outlined, this group of experts established a series of recommendations and designed a management algorithm.

Keywords: ICU; KPC; Klebsiella pneumoniae; VAP; carbapenemase-producing Enterobacterales (CPE); cefiderocol; ceftazidime-avibactam; imipenem-relebactam; meropenem-vaborbactam; nosocomial pneumonia.

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Conflict of interest statement

A.R., C.F., C.S., E.D., E.M., F.X.N., G.A., I.M.-L., M.B., M.N., P.R. and R.F. declare no conflict of interest. G.B. has participated in educational programs and consultancies organized by MSD, Pfizer, Shionogi and Menarini, and has received research funding from Pfizer and MSD. J.T.-C. has served as scientific advisor for Pfizer, Merck, Shionogi and Menarini, as an expert in the production of a consensus document for InfectoPharm and has received payment for lectures, including service on speakers bureaus and the development of educational presentations for Pfizer, Merck, Shionogi and Menarini. M.S. has given talks and participated in consultancies and educational programs organized or sponsored by the following companies: Angelini, Gilead, Menarini, MSD, Pfizer and Shionogi. P.V.-C. has received payment for lectures from Pfizer, MSD, Shionogi and Menarini. R.C. has participated in educational programs organized by MSD, Pfizer and Shionogi and has received research support from MSD, Shionogi and Venatorx Pharmaceuticals. R.Z. has received payment for lectures from MSD and Shionogi.

Figures

Figure 1
Figure 1
Clinical management algorithm arising from the ANGEL cohort. Reproduced with the kind permission of the authors of reference [45].
Figure 2
Figure 2
Activity of new antibiotics against Klebsiella pneumoniae resistant to carbapenems, according to resistance mechanisms. Green, susceptible; red, resistant. * Despite the fact that vaborbactam and relebactam are not able to inhibit OXA-48, both imipenem and meropenem have activity against some strains.
Figure 3
Figure 3
KPUCI algorithm decision to use the new drugs reported against carbapenemase-producing K. pneumoniae. KPUCI: Klebsiella pneumoniae in ICU group.
See this image and copyright information in PMC

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