Klebsiella infection, resistance

Meyer KS, Urban C, Eagan JA, Berger BJ, Rahal JJ. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993 119 353-358. 

Carbenicillin cures serious infections caused by Pseudomonas species and Proteus strains resistant to ampiciUin. It is not absorbed from the gastrointestinal tract, and therefore must be administered intraperitoneally. Carbenicillin indanyl is acid stable and hence can be given orally. TicarcilUn is four times more potent than carbenicillin in treating a Pseudomonas aeruginosa infection, and aziociUin is ten times more potent than carbenicillin against Pseudomonas. Mezlocillin and piperacillin are more active against Klebsiella infection than carbenicillin. 

Merino S, Camprubi S, Alberti S et al. Mechanisms of Klebsiella pneumoniae resistance to complement-mediated killing. Infect Immun 1992 60 2529-2535. 

Some of the most clinical significant bacteria involved in drug-resistant infections include (Table 6.1) Acinetobacter baumannii, P aeruginosa, Escherichia coli and Klebsiella pneumoniae resistant to j lactamases, along with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Staphylococcus aureus (VRSA), and Mycobacterium tuberculosis. (Alekshun and Levy 2(X)7 Lee et al. 2008 Ojha et al. 2008 Weigel et al. 2007). Resistance mechanisms allow bacteria... 

The first-generation and oldest quinolones exhibit limited gram-negative activity. Nalidixic acid and cinoxacin do not achieve systemic antibacterial levels and are thus restricted to therapy of bladder infections caused by urinary pathogens, such as E. coli and Klebsiella and Proteus spp. Although they are bactericidal agents, their use is restricted by resistance. 

Meropenem (Merrem) is another carbapenem antibiotic with a broad spectrum of activity comparable to that of imipenem. A methyl group attached at the one-position on the five-member ring confers stability to dehydropeptidase 1. Consequently, meropenem does not require administration with cilastatin. When compared in human trials, imipenem-cilastatin and meropenem achieve similar clinical outcomes in patients with serious intraabdominal and soft tissue infections. Both imipenem-cilastatin and meropenem are used to treat infections caused by highly resistant Klebsiella pneumoniae producing ESBLs.The major cUnicaUy relevant distinction between imipenem-cilastatin and meropenem... 

Used in all types of infection caused by Salmonella typhi, Klebsiella, Enterobacter, Pneumocystis carinii etc. and many other sulfonamide resistant stains of S. aureus, Strep, pyogenes, Shigella, E. coli, H. influenzae, meningococci and gonococci etc. It is particularly effective as a second line agent in penicillin allergic patients and also in patients where newer antibiotics are contraindicated or can t be used. 

A combination of trimethoprim-sulfamethoxazole is effective treatment for a wide variety of infections including P jiroveci pneumonia, shigellosis, systemic salmonella infections, urinary tract infections, prostatitis, and some nontuberculous mycobacterial infections. It is active against most Staphylococcus aureus strains, both methicillin-susceptible and methicillin-resistant, and against respiratory tract pathogens such as the pneumococcus, Haemophilus sp, Moraxella catarrhalis, and Klebsiella pneumoniae (but not Mycoplasma pneumoniae). However, the increasing prevalence of strains of E coli (up to 30% or more) and pneumococci that are resistant to trimethoprim-sulfamethoxazole must be considered before using this combination for empirical therapy of upper urinary tract infections or pneumonia. 

Due to its powerful specific activity against commonly isolated community-acquired respiratory tract pathogens [33,149-158], including penicillin-sensitive and -resistant Streptococcus pneumoniae, methicillin-sensitive Staphylococcus aureus, Haemophilus spp., Moraxella catarrhalis and atypical pathogens such as Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila and Klebsiella pneumoniae and anaerobic bacteria [159-162], moxifloxacin was developed as a respiratory tract anti-infective [163-168]. 

Henry, M.C., R.Ehrlich, and W.H.Blair. 1969. Effect of nitrogen dioxide on resistance of squirrel monkeys to Klebsiella pneumoniae infection. Arch. Environ. Health 18(4) 580—587. 

Kanamycin can be used for short-term treatment of severe infections caused by susceptible strains (for example Escherichia coli, Proteus species, Enterobacter aerogenes, Klebsiella pneumoniae, Serratia marcescens, and Mima-Elerellea) that are resistant to other less ototoxic aminoglycosides. It is not indicated for long-term therapy, for example in tuberculosis. 

Segal-Maurer S, Mariano N, Qavi A, Urban C, Rahal JJ Jr. Successful treatment of ceftazidime-resistant Klebsiella pneumoniae ventriculitis with intravenous meropenem and intraventricular polymyxin B case report and review. Clin Infect Dis 1999 28(5) 1134-8. 

The true chemotherapeutic significance of this phenomenon is not defined at the moment but it requires careful scrutiny since it involves so many drugs and so many organisms (Coli, Salmonella, Klebsiella, Shigella, Vibrio). Perhaps, by means of this new look at a bacterially old process, we will now be able to devise a cure for this "infectious disease" of bacteria which will be effective in vivo and will finally enable us to deal with the important problem of bacterial resistance (cf. a clinical study9 of atebrin in combination therapy of multi-drug-resistant urinary infections). 

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