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Treatment of Klebsiella pneumoniae Carbapenemase–Producing Klebsiella pneumoniae Bacteremia With Meropenem, Colistin, and Ceftazidime-Avibactam: A Case Report

Harrison, Kiya PharmD*; Smith, Winter PharmD; Kupiec, Katherine PharmD; Salinas, Linda MD§; McCloskey, Cindy MD; Robison, Denise MS, MT (ASCP) SM; Salvaggio, Michelle MD§

Infectious Diseases in Clinical Practice: July 2017 - Volume 25 - Issue 4 - p 223–225
doi: 10.1097/IPC.0000000000000492
Case Reports

Abstract: Ceftazidime-avibactam is a novel combination antimicrobial agent consisting of a broad-spectrum cephalosporin, ceftazidime, and a non–β-lactam β-lactamase inhibitor, avibactam. This agent has demonstrated activity against resistant gram-negative bacteria, including Klebsiella pneumoniae carbapenemase–producing organisms; however, it is US Food and Drug Administration approved for use in urinary tract and intra-abdominal infections only. We present a case of successful treatment of K. pneumoniae carbapenemase–producing K. pneumoniae bacteremia with a combination of meropenem and colistin followed by ceftazidime-avibactam and colistin.

Ceftazidime-avibactam is currently approved for the treatment of complicated urinary tract and intra-abdominal infections only. The authors present the case of a patient with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae bacteremia treated effectively with a combination of meropenem and colistin followed by ceftazidime-avibactam and colistin. This agent may represent a therapeutic option for the treatment of bacteremia due to KPC-producing K. pneumoniae when first-line agents cannot be used.

From the *College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK; †School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX; and ‡Department of Pharmacy, OU Medical Center; Sections of §Infectious Diseases and ∥Pathology, Department of Medicine, University of Oklahoma Health Sciences Center; and ¶Microbiology Laboratory, OU Medical Center, Oklahoma City, OK.

Correspondence to: Kiya Harrison, PharmD, College of Pharmacy, University of Oklahoma Health Sciences Center, 1122 NE 13th St, Ste 4414, Oklahoma City, OK 73117. E-mail: Kiya-Harrison@ouhsc.edu.

For C.M. and D.R., Allergan provided research use only–labeled susceptibility test materials (disks for disk diffusion and E test strips) and sponsored reference laboratory susceptibility testing (Laboratory Specialists, Inc, Westlake, Ohio) for any interested institution during the time frame this study took place. These resources would have been available to any requesting clinical laboratory at that time. Manufacturers typically provide these kinds of resources to the clinical laboratory community when introducing new antimicrobial products on the market. The remaining authors have no conflicts of interest to disclose.

Written informed consent was obtained from the patient for publication of this case report.

Of note, ceftazidime-avibactam was used for an off-label purpose in this case. As stated in the article, it is only FDA approved for urinary tract and intra-abdominal infections, not bacteremia as used in this patient case.

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