Treatment: Klebsiella Infections

• Klebsiellae are resistant to ampicillin and ticarcillin.
  • - The increase in plasmid-encoded ESBLs has led to increasing resistance to third- and fourth-generation cephalosporins, aminoglycosides, tetracyclines, and TMP-SMX.
  • - Fluoroquinolone resistance is increasing, especially among ESBL-containing strains.
• Empirical treatment of serious or health care-associated Klebsiella infections with amikacin or carbapenems is prudent; however, carbapenemase-producing strains are increasing in frequency. Optimal therapy for carbapenemase strains is unclear, but tigecycline and the polymyxins (e.g., colistin) are used most frequently on the basis of in vitro susceptibility profiles. When resistance to these agents is documented, combination therapy is often used.