A Klebsiella pneumoniae isolate from an ICU patient with pneumonia shows meropenem MIC of 32 μg/mL. Modified Carbapenem Inactivation Method (mCIM) is positive. KPC is detected by molecular testing. What is the treatment of choice?
- A High-dose meropenem extended infusion alone
- B Colistin monotherapy
- C Ceftazidime-avibactam (or meropenem-vaborbactam) ✓
- D Tigecycline monotherapy
Correct answer: C. Ceftazidime-avibactam (or meropenem-vaborbactam)
Explanation
KPC (Klebsiella pneumoniae carbapenemase) is a Class A serine carbapenemase; avibactam (a non-beta-lactam BLI) inhibits KPC effectively, making ceftazidime-avibactam the preferred treatment for KPC-producing CRE. Meropenem-vaborbactam is an alternative BLI combination active against KPC. Colistin monotherapy has high toxicity and resistance rates; it is a last resort. Tigecycline monotherapy has poor bactericidal activity and is associated with clinical failures in bacteremia. High-dose meropenem is insufficient when MIC is 32 μg/mL.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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