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Treatment Options for Colistin Resistant Klebsiella pneumoniae: Present and Future

Nicola Petrosillo1, Fabrizio Taglietti2, Guido Granata3

  • 1Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS-Via Portuense, 292 00149 Rome, Italy. nicola.petrosillo@inmi.it.

Journal of Clinical Medicine
|July 3, 2019
PubMed

Insights

Multidrug-resistant Klebsiella pneumoniae infections are a growing concern. This review covers treatments for colistin-resistant strains, including current options and emerging therapies like plazomicin and bacteriophages.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Multidrug-resistant (MDR) Klebsiella pneumoniae poses a significant global health threat, leading to high-mortality infections.
  • Colistin is a critical last-resort antibiotic for carbapenem-resistant K. pneumoniae, making colistin resistance a major clinical challenge.
  • Limited effective treatment options exist for colistin-resistant K. pneumoniae infections, necessitating exploration of alternative antimicrobials.

Purpose of the Study:

  • To review the characteristics of colistin resistance in K. pneumoniae.
  • To describe currently available and novel antimicrobial agents for treating colistin-resistant MDR K. pneumoniae.
  • To discuss emerging therapeutic strategies for these challenging infections.

Main Methods:

  • Literature review of existing studies on colistin resistance mechanisms in K. pneumoniae.
  • Analysis of pharmacokinetic/pharmacodynamic properties, efficacy, and safety profiles of current and novel antimicrobials.
  • Exploration of ongoing research into innovative treatments such as bacteriophage therapy and monoclonal antibodies.

Main Results:

  • Colistin resistance in K. pneumoniae is an escalating problem, complicating treatment decisions.
  • Existing alternatives like tigecycline, gentamicin, fosfomycin, and ceftazidime/avibactam have limitations based on patient factors and isolate susceptibility.
  • New agents like plazomicin and cefiderocol show promise, alongside developing strategies like phage therapy.

Conclusions:

  • Effective management of colistin-resistant MDR K. pneumoniae requires careful consideration of available agents and emerging therapies.
  • Novel antimicrobials and innovative strategies are crucial to combat the rising threat of multidrug resistance in K. pneumoniae.
  • Continued research into alternative treatments is essential to address the limitations of current therapeutic options.
Keywords:
CefiderocolCeftazidime/AvibactamColistinColistin-resistantFosfomycinKlebsiella pneumoniaePlazomicinTigecyclin

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