A 70-year-old man in ICU with ventilator-associated pneumonia (VAP) has been on meropenem for 5 days. Bronchoalveolar lavage culture grows Klebsiella pneumoniae with MIC for meropenem of 4 μg/mL and carbapenemase gene (blaKPC) positive. The most appropriate antibiotic regimen for this KPC-producing Klebsiella is:
- A High-dose meropenem continuous infusion
- B Polymyxin B monotherapy
- C Ceftazidime-avibactam ✓
- D Tigecycline alone
Explanation
Ceftazidime-avibactam is the drug of choice for KPC-producing carbapenem-resistant Enterobacteriaceae (CRE). Avibactam is a non-beta-lactam beta-lactamase inhibitor that inhibits class A (KPC), class C (AmpC), and class D (OXA-48) carbapenemases. Multiple clinical trials and observational studies have shown significantly superior outcomes with ceftazidime-avibactam compared to polymyxin-based regimens for KPC-producing Klebsiella. Polymyxins have nephrotoxicity and suboptimal tissue penetration for pulmonary infections. Tigecycline has poor bactericidal activity and high relapse rates for bloodstream/VAP. High-dose meropenem is only applicable when MIC ≤4 but KPC production makes this unreliable.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.