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Trimethoprim–sulfamethoxazole therapy for patients with carbapenemase-producing Klebsiella pneumoniae infections: retrospective single-center case series

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Abstract

Objective

The objective of the study was to evaluate the efficacy and tolerability of trimethoprim–sulfamethoxazole (also known as co-trimoxazole, TMPS) to treat Klebsiella pneumoniae (Kp)-K. pneumoniae carbapenemase (KPC) infections.

Methods

Clinical data of patients with a TMPS-susceptible Kp-KPC infection were collected as a case series.

Results

We report clinical outcomes and tolerability for 14 patients infected by Kp-KPC strains susceptible to TMPS, including three bloodstream infections. In ten cases (71.4%), TMPS was administered as monotherapy. In all but one case, Kp-KPC infection was cured. In the remaining patient, therapy was discontinued because of an adverse event.

Conclusions

The use of TMPS to treat TMPS-susceptible Kp-KPC infections seems promising.

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References

  1. European Antimicrobial Resistance Surveillance Network (EARS-Net). http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/table_reports.aspx. Accessed Nov 2016.

  2. Maltezou HC, Giakkoupi P, Maragos A, et al. Outbreak of infections due to KPC-2-producing Klebsiella pneumoniae in a hospital in Crete (Greece). J Infect. 2009;58:213–9.

    Article  CAS  PubMed  Google Scholar 

  3. Souli M, Galani I, Antoniadou A, et al. An outbreak of infection due to beta-Lactamase Klebsiella pneumoniae Carbapenemase 2-producing K. pneumoniae in a Greek University Hospital: molecular characterization, epidemiology, and outcomes. Clin Infect Dis. 2010;50:364–73.

    Article  CAS  PubMed  Google Scholar 

  4. Grundmann H, Livermore DM, Giske CG, et al. Carbapenem-non-susceptible Enterobacteriaceae in Europe: conclusions from a meeting of national experts. Euro Surveill 2010;15.

  5. Freire MP, Abdala E, Moura ML, et al. Risk factors and outcome of infections with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae in kidney transplant recipients. Infection. 2015;43:315–23.

    Article  CAS  PubMed  Google Scholar 

  6. Tumbarello M, Trecarichi EM, De Rosa FG, et al. Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in a multicentre study. J Antimicrob Chemother. 2015;70:2133–43.

    Article  CAS  PubMed  Google Scholar 

  7. Daikos GL, Tsaousi S, Tzouvelekis LS, et al. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother. 2014;58:2322–8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Qureshi ZA, Paterson DL, Potoski BA, et al. Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: superiority of combination antimicrobial regimens. Antimicrob Agents Chemother. 2012;56:2108–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. van der Donk CF, Beisser PS, Hoogkamp-Korstanje JA, Bruggeman CA, Stobberingh EE, Antibiotic Resistance Surveillance Group. A 12 year (1998-2009) antibiotic resistance surveillance of Klebsiella pneumoniae collected from intensive care and urology patients in 14 Dutch hospitals. J Antimicrob Chemother. 2011;66:855–8.

    Article  PubMed  Google Scholar 

  10. Lombardi F, Gaia P, Valaperta R, et al. Emergence of Carbapenem-Resistant Klebsiella pneumoniae: progressive spread and four-year period of observation in a cardiac surgery division. Biomed Res Int. 2015;2015:871947.

    PubMed  PubMed Central  Google Scholar 

  11. Oteo J, Ortega A, Bartolomé R, et al. Prospective multicenter study of carbapenemase-producing Enterobacteriaceae from 83 hospitals in Spain reveals high in vitro susceptibility to colistin and meropenem. Antimicrob Agents Chemother. 2015;59:3406–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Bremmer DN, Clancy CJ, Press EG, et al. KPC-producing Klebsiella pneumoniae strains that harbor AAC(6′)-Ib exhibit intermediate resistance to amikacin. Antimicrob Agents Chemother. 2014;58:7597–600.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Walsh TR, Toleman MA, Poirel L, et al. Metallo-b-lactamases: the quiet before the storm? Clin Microbiol Rev. 2005;18:306–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol. 2013;34:1–14.

    Article  PubMed  Google Scholar 

  15. Giani T, Pini B, Arena F, et al. Epidemic diffusion of KPC carbapenemase-producing Klebsiella pneumoniae in Italy: results of the first countrywide survey, 15 May to 30 June 2011. Euro Surveill 2013;18:20849.

  16. ECDC. Annual epidemiological report 2013: reporting on 2011 surveillance data and 2012 epidemic intelligence data. Stockholm: European Centre for Disease Prevention and Control; 2013. http://ecdc.europa.eu/en/publications/Publications/annual-epidemiological-report-2013.pdf.. Accessed Jan 2017.

    Google Scholar 

  17. Falagas ME, Rafailidis PI. Nephrotoxicity of colistin: new insight into an old antibiotic. Clin Infect Dis. 2009;48:1729–31.

    Article  CAS  PubMed  Google Scholar 

  18. Monaco M, Giani T, Raffone M, et al. Colistin resistance superimposed to endemic carbapenem-resistant Klebsiella pneumoniae: a rapidly evolving problem in Italy, November 2013 to April 2014. Euro Surveill. 2014;23:19.

    Google Scholar 

  19. Kontopidou F, Giamarellou H, Katerelos P, et al. Infections caused by carbapenem-resistant Klebsiella pneumoniae among patients in intensive care units in Greece: a multi-centre study on clinical outcome and therapeutic options. Clin Microbiol Infect. 2014;20:O117–23.

    Article  CAS  PubMed  Google Scholar 

  20. Neuner EA, Yeh JY, Hall GS, et al. Treatment and outcomes in carbapenem-resistant Klebsiella pneumoniae bloodstream infections. Diagn Microbiol Infect Dis. 2011;69:357–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Freire AT, Melnyk V, Kim MJ, et al. Comparison of tigecycline with imipenem/cilastatin for the treatment of hospital-acquired pneumonia. Diagn Microbiol Infect Dis. 2010;68:140–51.

    Article  CAS  PubMed  Google Scholar 

  22. Akova M, Daikos GL, Tzouvelekis L, Carmeli Y. Interventional strategies and current clinical experience with carbapenemase-producing Gram-negative bacteria. Clin Microbiol Infect. 2012;18:439–48.

    Article  CAS  PubMed  Google Scholar 

  23. Tumbarello M, Viale P, Viscoli C, et al. Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy. Clin Infect Dis. 2012;55:943–50.

    Article  CAS  PubMed  Google Scholar 

  24. Ji S, Lv F, Du X, et al. Cefepime combined with amoxicillin/clavulanic acid: a new choice for the KPC-producing Klebsiella pneumoniae infection. Int J Infect Dis. 2015;38:108–14.

    Article  CAS  PubMed  Google Scholar 

  25. Limbago BM, Rasheed JK, Anderson KF, et al. IMP-producing carbapenem-resistant Klebsiella pneumoniae in the US. J Clin Microbiol. 2011;49:4239–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Ahn C, Syed A, Hu F, O’Hara JA, Rivera JI, Doi Y. Microbiological features of KPC-producing enterobacter isolates identified in a US hospital system. Diagn Microbiol Infect Dis. 2014;80:154–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We are grateful to Leonida Passeri for his technical assistance in data management.

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Authors and Affiliations

  1. Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy

    Rita Murri, Barbara Fiori, Teresa Spanu, Ilaria Mastrorosa, Francesca Giovannenze, Francesco Taccari, Claudia Palazzolo, Giancarlo Scoppettuolo, Giulio Ventura, Maurizio Sanguinetti, Roberto Cauda & Massimo Fantoni

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  1. Rita Murri
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  2. Barbara Fiori
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  3. Teresa Spanu
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  4. Ilaria Mastrorosa
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  5. Francesca Giovannenze
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  6. Francesco Taccari
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  7. Claudia Palazzolo
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  8. Giancarlo Scoppettuolo
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Corresponding author

Correspondence to Rita Murri.

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Funding

No funding has been received for this study. The present manuscript was revised by San Francisco Edit, which was supported by internal funding. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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Murri, R., Fiori, B., Spanu, T. et al. Trimethoprim–sulfamethoxazole therapy for patients with carbapenemase-producing Klebsiella pneumoniae infections: retrospective single-center case series. Infection 45, 209–213 (2017). https://doi.org/10.1007/s15010-016-0968-x

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  • DOI: https://doi.org/10.1007/s15010-016-0968-x

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