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Treatment of Klebsiella Pneumoniae Carbapenemase (KPC) infections: a review of published case series and case reports

Grace C Lee, David S Burgess

Annals of Clinical Microbiology and Antimicrobials · 2012 · Systematic review

doi:10.1186/1476-0711-11-32

Abstract

The emergence of Klebsiella pneumoniae carbapenemases (KPCs) producing bacteria has become a significant global public health challenge while the optimal treatment remains undefined. We performed a systematic review of published studies and reports of treatment outcomes of KPC infections using MEDLINE (2001-2011). Articles or cases were excluded if one of the following was fulfilled: no individual patient data provided, no treatment regimen specified, no treatment outcome specified, report of colonization, or greater than three antibiotics were used to treat the KPC infection. Data extracted included patient demographics, site of infection, organism, KPC subtype, antimicrobial therapy directed at KPC-infection, and treatment outcome. Statistical analysis was performed in an exploratory manner. A total of 38 articles comprising 105 cases were included in the analysis. The majority of infections were due to K. pneumoniae (89%). The most common site of infection was blood (52%), followed by respiratory (30%), and urine (10%). Forty-nine (47%) cases received monotherapy and 56 (53%) cases received combination therapy directed at the KPC-infection. Significantly more treatment failures were seen in cases that received monotherapy compared to cases who received combination therapy (49% vs 25%; p= 0.01). Respiratory infections were associated with higher rates of treatment failure with monotherapy compared to combination therapy (67% vs 29% p= 0.03). Polymyxin monotherapy was associated with higher treatment failure rates compared to polymyxin-based combination therapy (73% vs 29%; p= 0.02); similarly, higher treatment failure rates were seen with carbapenem monotherapy compared to carbapenem-based combination therapy (60% vs 26%; p= 0.03). Overall treatment failure rates were not significantly different in the three most common antibiotic-class combinations: polymyxin plus carbapenem, polymyxin plus tigecycline, polymyxin plus aminoglycoside (30%, 29%, and 25% respectively; p=0.6). In conclusion, combination therapy is recommended for the treatment of KPC infections; however, which combination of antimicrobial agents needs to be established in future prospective clinical trials.

Full text

From PubMed Central, U.S. National Library of Medicine, as current on Oct 22, 2026. Paragraph numbers are ours, so an answer can point at one.

Introduction

The increasing incidence of Klebsiella pneumoniae carbapenemases (KPCs) is a significant public health challenge. Previously confined to sporadic outbreaks in the northeastern United States, KPCs have now spread throughout the world and have reached endemic proportions in countries such as Israel and Greece. Furthermore, KPC-producing organisms can confer resistance to multiple different antimicrobial classes, including all available β-lactams, fluoroquinolones, and aminoglycosides. As such, infections due to KPCs are associated with high therapeutic failure and mortality rates of at least 50%. The limited number of agents available for the treatment of KPCs presents a tremendous challenge to clinicians. Given the lean pipeline of new antimicrobials, further investigations into optimal treatment modalities are urgently needed. However, studies on the treatment of KPC infections are scarce and mainly limited to case series and case reports. Therefore, we sought to perform a systematic review of individual cases in an effort to summarize therapeutic outcomes of various treatment regimens for KPC infections.

Case selection

A systematic review of English language articles using MEDLINE (2001–2011) was conducted. Additional studies were identified by searching bibliographies of primary articles and annual conference abstracts from 2008–2011. Search terms included kpc.mp, Drug Therapy/mt, mo, Treatment Outcome, Case Reports, and Disease Outbreaks/pc. All searches were limited to humans. Articles were eligible if they included patients with infections due to KPC-producing bacteria. Articles were excluded from further review if they fulfilled at least one of the following criteria: no individual patient data reported, no treatment regimen specified, no treatment outcome specified, or greater than three antibiotics or multiple antibiotic regimens directed at the KPC infection. Clinical success and failures were recorded as reported by the authors of each report. Analysis of the proportion of clinical failures was calculated as the number of failures divided by the number of treated patients. Several characteristics from the cases were extracted including the patient’s age, sex, medical history, site(s) of infection, type of infection, organism, KPC subtype, APACHE II score, admission to the intensive care unit (ICU), length of stay before infection, total length of stay, minimum inhibitory concentration (MIC) of selected antimicrobials (carbapenem, polymyxin, and tigecycline), antimicrobial therapy before isolation, antimicrobial therapy directed at KPC-infection, and treatment outcome. Antimicrobial agents were categorized into the following classes: polymyxins, carbapenems, glycylcycline, aminoglycosides, cephalosporins, beta-lactam plus beta-lactamase inhibitors, fluoroquinolones, trimethoprim-sulfamethoxazole, monobactams, fosfomycin, and tetracyclines. Combination therapy was defined as at least two but no more than three, antibiotics with gram-negative activity reported to be directed at KPC infections. Statistical analysis was performed in an exploratory manner. Comparisons were made using χ2 or Fisher's exact test for categorical variables using JMP 8.0 ® (SAS Corp, Cary, NC).

Study characteristics

A total of 54 relevant articles were identified searching MEDLINE, 12 from bibliographies of retrieved articles, and 61 from conference abstracts (Figure 1). Of these 127 citations, 62 articles were eligible for review for study inclusion. A total of 24 articles were excluded for the following reasons: no patient specific treatment and/or outcomes (n=18), greater than three antimicrobials (n=4), and reports of colonization (n=2). Within the 38 articles included, 34 individual cases were excluded for the following reasons: no patient specific treatment and/or outcomes (n=15), greater than three antimicrobials (n=9), and reports of colonization (n=10). A total of 38 reports comprising 105 cases met the inclusion criteria, and consisted of case series (47%), retrospective cohort studies (35%), and case reports (17%). The majority of reports were from the US (42%), followed by Greece (10%). As expected, the number of studies reported per year increased. The majority of the articles (58%) for this review were published in 2009 and 2011.

Several limitations should be noted. Individual studies/reports did not always define treatment failure or treatment success. Antimicrobial dosing, procedures, residual colonization, antimicrobial timing were not always reported and therefore not considered in the outcome analysis.

Characteristics of cases

Characteristics of cases evaluated in this review are presented in Table 1. The mean age was 62 years ± 19, 55% were males, and 72% were admitted to the ICU. The mean APACHE II Score was 20.6 ± 8, the mean length of stay before infection was 17.5 days ± 19, while the mean total length of stay was 54.8 days ± 40. Infection characteristics are described in Table 2. Most of the reported infections were due to KPC-2 (86%). Organisms largely comprised of K. pneumoniae (89%), followed distantly by Pseudomonas spp (4%), E. coli (3%), S. marcescens (3%), and E. cloacae (2%). The most common site of infection was blood (52%), followed by lung (30%), and urine (10%).

Treatment of KPC infections

Cases received regimens containing the following antimicrobials or antimicrobial classes: 45 cases received a polymyxin, 39 cases received a carbapenem, 30 cases received an aminoglycoside, 26 cases received a glycylcycline, 7 cases received a fluoroquinolone, 5 cases received a beta-lactam plus beta-lactamase inhibitor, 2 cases received cephalosporins, 2 cases received a tetracycline, 2 cases received a monobactam, 1 case received fosfomycin, and 1 case received trimethoprim-sulfamethoxazole. Overall, 49 (47%) cases received monotherapy and 56 (53%) cases received combination therapy directed at KPC-infections.

Summary of treatment outcomes

A summary of the treatment outcomes is provided in Table 3. The overall rate of treatment failure was 36% (38/105). Pulmonary infections were associated with the highest rate of treatment failure (47%) followed by blood infections (39%). Of the cases with KPC infections due to Klebsiella species, 62% (57/92) reported treatment success, 50% (1/2) for Enterobacter cloacae, 100% (3/3) for Serratia marcescens, and 100% (3/3) for E. coli. Interestingly, all 4 cases of Pseudomonal KPC infections reported treatment failure. Infections with blakpc-3 had a higher rate of treatment failure than blakpc-2 (36% vs. 50%; p = 0.35). Pathogens harboring blakpc-3 consisted of K. pneumoniae (12; 86%) and Raoultella spp (2; 14%).

Polymyxins

Polymyxin monotherapy had higher rates of treatment failure compared to polymyxin-based combination therapy (73% vs 29%; p= 0.02). Of the 11 cases who received polymyxin monotherapy, 73% (8/11) experienced treatment failure. Of the nine patients treated for bloodstream infections (BSIs), six patients were treatment failures. Both patients treated for pneumonia with colistin monotherapy failed treatment. Among cases who received polymyxin-based combination therapy, 71% (24/34) patients had successful treatment outcomes. Of these 24 patients, the most common treatment regimen was tigecycline plus colistin (50%), followed by carbapenem plus polymyxin (33%) and aminoglycosides plus polymyxin (13%). Twenty-nine percent of patients (10/34) who received polymyxin-based combination therapy experienced treatment failure. Five patients were treated for BSIs with the following regimens: carbapenem plus colistin (3), tigecycline plus colistin (1), and amikacin plus colistin (1). In the latter case, the patient developed colistin resistance (MIC 0.25 μg/mL to 16 μg/mL) while on treatment and eventually died. The other five cases of treatment failure consisted of cases of pulmonary infection treated with the following antimicrobials in combination with a polymyxin: tigecycline (3), carbapenem (1), and fluoroquinolone (1).

Although polymyxins were the most commonly used antimicrobial against KPC infections in this review, the effectiveness of polymyxins for the treatment of KPC infections is not well established. Various in-vitro studies have demonstrated bactericidal activity and synergy when polymyxins are tested in combination with carbapenems, rifampin or tigecycline, while monotherapy often led to significant re-growth by 24 hours. Furthermore, a report by Lee and colleagues evaluated 12 patients with persistent blood cultures positive for KPC-K. pneumoniae despite 3 days of treatment with either polymyxin B alone or polymyxin B plus tigecycline. Interestingly, 3 of the 12 patients who received polymyxin B monotherapy had significant increases in MIC values (1.5 μg/mL to 32 μg/mL, 0.75 μg/mL to 12 μg/mL, and 0.75 μg/mL to 1024 μg/mL) while none of the patients who received polymyxin B in combination with tigecycline developed resistance. The authors hypothesized that combination therapy may have prevented resistance in patients who received both polymyxin B and tigecycline. Similar reports of gram negative organisms developing resistance to colistin have been described. Polymyxins are one of the few antimicrobial classes that remain susceptible to KPC-producing organisms. Increasing reports of polymyxin resistance described in case reports and recent outbreaks of polymyxin-resistant strains are troubling. Combination therapy may be an important strategy for the management of KPC infections when utilizing polymyxins. However, determining which antimicrobial in combination with polymyxins is superior still needs to be established in further clinical studies.

Carbapenems

Of the 39 cases who received a carbapenem, 51% (20/39) received carbapenem monotherapy and 49% (19/39) received carbapenem-based combination therapy. Carbapenem monotherapy had higher rates of treatment failure compared to carbapenem-based combination therapy (60% versus 26% p=0.03). Of the 20 cases who received carbapenem monotherapy, 55% (11/20) failed treatment, including 6 cases with strains having MICs ≤4 μg/mL (previous CLSI breakpoint for imipenem and meropenem). The majority of those who failed treatment had pneumonia or tracheobronchitis (7), followed by BSI (3), and urinary tract infection (UTI) (1). Among cases who received carbapenem-based combination therapy, 74% of patients (14/19) had successful treatment outcomes. In these 14 patients, the most common treatment regimen was polymyxin plus carbapenem (8), followed by aminoglycoside plus carbapenem (4), and beta-lactam plus beta-lactamase inhibitor plus carbapenem (2). A total of 5 patients receiving carbapenem-based combination therapy experienced treatment failure. All but one of these 5 patients were treated with a carbapenem plus polymyxin.

Several issues regarding the use of carbapenems for the treatment of KPC-infections should be considered. Nine of the cases who received carbapenem monotherapy were reported from one retrospective case series. In the retrospective review, patients infected with imipenem non-susceptible KPC K. pneumoniae (MIC > 4 μg/mL) treated with alternative therapies had a higher rate of successful treatment (8/10, 80%) when compared with patients infected with imipenem-susceptible (MIC ≤ 4 μg/mL) KPC K. pneumoniae treated with a carbapenem (4/9, 44.4%). The optimal pharmacodynamic parameter for carbapenems is the time the free carbapenem concentration remains above the MIC (%T > MIC); however, whether this parameter is valid in the presence of KPCs is controversial. In a mouse thigh infection model, Craig et al. demonstrated that the presence of KPCs had no impact on achieving pharmacodynamic parameters of strains with MICs up to 16 μg/mL. There has been only one case report describing the successful use of high-dose continuous infusion meropenem monotherapy for a carbapenem non-susceptible KPC K. pneumoniae (MIC= 8 μg/mL) BSI. In contrast, an in vitro model, simulating human exposure to a high-dose prolonged-infusion meropenem (2 g every 8 h over 3-hr infusion), demonstrated that the killing activity at 24 hours, against KPC-producing K. pneumoniae strains, were inferior to non-carbapenemase-producing Pseudomonas aeruginosa strains despite similar meropenem MICs. The authors attributed this to the rapid in-vitro hydrolysis of meropenem, resulting in lower exposure of meropenem to the KPC K. pneumoniae. The Clinical and Laboratory Standards Institute (CLSI) recently lowered clinical breakpoints of carbapenems to exclude KPC-producing organisms in the previous susceptible range. Susceptibilities to imipenem, meropenem and doripenem have been defined by an MIC up to 1 μg/mL and 0.5 μg/mL for ertapenem. The utility of carbapenem monotherapy against strains containing KPCs remains controversial. Until further data are available, the use of combination or alternative therapy may be warranted.

Tigecycline

Of the 26 cases who received tigecycline, 7 cases received tigecycline monotherapy and 19 received tigecycline-based combination therapy. There was no significant difference in treatment failure rates between cases receiving tigecycline monotherapy compared to those receiving combination therapy (29% vs. 37%;p = 0.4). Twenty-nine percent (2/7) of patients who received tigecycline monotherapy experienced treatment failure. One patient was treated for urosepsis and the other was treated for nosocomial pneumonia and empyema. In the latter, even though a long course of tigecycline resolved the pneumonia, treatment was complicated by recurrence of empyema associated with an increase in tigecycline MIC from 0.75 to 2 μg/mL. Of the 19 patients who received tigecycline combination therapy, 14 (74%) received polymyxin plus tigecycline, 3 (16%) received tigecycline plus aminoglycoside, and 2 (11%) received tigecycline plus carbapenem. Both patients who received tigecycline plus a carbapenem experienced treatment failures. In one report, despite a month-long course of tigecycline and meropenem for KPC-K. pneumoniae bacteremia secondary to sclerosing cholangitis, the patient experienced relapse of the bacteremia which was associated with the development of resistance to both meropenem and tigecycline.

Tigecycline has demonstrated excellent spectrum of activity against KPC-producing organisms. In a collection of 106 carbapenemase-producing strains from various countries, tigecycline was the only antimicrobial with 100% activity. However, there are no breakpoints set by the CLSI for tigecycline for Enterobacteriaceae (FDA-approved breakpoint for tigecycline is < 2 μg/mL). In addition, tigecycline has limited activity against Pseudomonas species. Clinical issues with tigecycline’s pharmacokinetic properties may raise some caution in treatment of UTIs and BSIs due to low urinary (< 22%) and low plasma (≤ 0.9 mg/L) concentrations. However, tigecycline has been used successfully in treating these infections; both patients included in this review who were treated with tigecycline monotherapy for their UTIs, were treated successfully. In contrast, in an evaluation of 48 patients with carbapenem-resistant K. pneumoniae bacteremia in a tertiary care hospital, all 8 patients with break-through bacteremias had received tigecycline reports of tigecycline resistance have been previously demonstrated in Enterobacteriaceae. Finally, tigecycline is a bacteriostatic agent; thus, alternative agents or combination therapy may be required for infections requiring bactericidal activity.

Aminoglycosides

A total of 30 cases received an aminoglycoside, 20% (6/30) of cases as monotherapy and 80% (24/30) as combination therapy. There was no significant difference in treatment failure rates between those who received aminoglycoside monotherapy compared to combination therapy (0% vs. 17%; p= 0.6). Interestingly, all six cases who received aminoglycoside monotherapy reported success: three cases were treated for BSIs, two cases were treated for UTIs, and one case was treated for a respiratory infection. A recent study demonstrated that aminoglycosides, when active in vitro, were associated with a significantly higher rate of microbiologic clearance of carbapenem-resistant K. pneumoniae in the urine compared to polymyxin B or tigecycline. Of the patients who received aminoglycoside-based combination therapy, the most common treatment was amikacin plus colistin (11), followed by aminoglycoside plus a carbapenem (4), aminoglycoside plus a fluoroquinolone (5), aminoglycoside plus tigecycline (2), gentamicin plus aztreonam (1), and amikacin plus tetracycline (1). Despite in-vitro evidence of antagonism when using polymyxins and aminoglycosides in combination, 6 clinical cases of polymyxin plus an aminoglycoside reported treatment success. All patients who failed therapy with aminoglycoside-based therapy had BSIs. One reported case had bacteremia due to KPC-2-producing E. cloacae and P. putida recovered simultaneously from multiple cultures; the patient eventually died. Herein, the most commonly employed aminoglycoside combination was amikacin plus colistin; but, the potential increased risk of nephrotoxicity with this combination is a major concern.

Combination versus monotherapy

Of all cases meeting the study inclusion criteria, 49 (47%) cases received monotherapy and 56 (53%) cases received combination therapy directed at KPC-infections. Significantly more treatment failures were seen in cases treated with monotherapy than those treated with combination therapy (49% vs. 25%; p= 0.01) (Table 4). Similar treatment failure rates were observed in the three most common antibiotic-class combinations: polymyxin plus a carbapenem, polymyxin plus tigecycline, polymyxin plus an aminoglycoside (30%, 29%, and 25% respectively; p=0.6). In three cases, triple antimicrobial therapy directed at the KPC infection was used: one case received doripenem plus polymyxin B plus rifampin and 2 cases received tigecycline plus colistin plus garamycin. All three cases were treated successfully.

A review of treatment outcomes versus sites of infection showed urinary sources of infection had the highest overall treatment success rates of 81% (9/11). A recent retrospective cohort study of 21 patients with UTIs described similar positive clinical responses in 16 (76%) patients. Of the 11 patients who were treated for UTIs in this review, the majority were treated with monotherapy (8/11), and of these patients, only one experienced treatment failure while on imipenem (MIC=4 μg/mL). The eight cases treated successfully with monotherapy received either a carbapenem (3), tigecycline (2), an aminoglycoside (1), ciprofloxacin (1) or cefepime (1). All 3 cases treated with combination therapy for UTIs reported treatment success. The pulmonary site of infection was associated with higher rates of treatment failure with monotherapy compared to combination therapy (67% vs. 29% p= 0.03). Among the 17 patients with pulmonary infections treated successfully, more than 75% of cases received combination therapy. The most common regimen for the successful treatment of pulmonary infections consisted of tigecycline plus colistin (8), followed by an aminoglycoside plus colistin (3). Likewise, there was a lower failure rate treating blood-stream infections with combination therapy compared to monotherapy, (28% vs. 50%; p=0.09).

Several recent studies have supported the role of combination therapy for treating KPC infections. In a cohort of 41 patients with KPC- K. pneumoniae bacteremia, the use of combination therapy was associated with improved 28-day mortality. The most common successful combination employed in this cohort was a polymyxin in combination with either tigecycline or a carbapenem. Tumbarello et al. conducted a study in three Italian hospitals and demonstrated that combination therapy, particularly a triple-drug regimen including tigecycline, colistin, plus a carbapenem, was independently associated with improved survival. Likewise, in a previous pool of 55 individual cases, combination therapy was associated with successful outcomes compared to monotherapy, particularly if polymyxins were part of the regimen.

Conclusion

Infections caused by KPC-producing bacteria have been associated with high mortality rates and frequent treatment failure. Clinical data on treatment are limited and appropriate therapy for KPC infections is not well defined. This review demonstrated that monotherapy is associated with higher treatment failure rates compared to combination therapy when managing infections due to KPC-producing bacteria, particularly when treating respiratory infections. Polymyxins and carbapenems when used alone were associated with higher treatment failure than when used in combination. Until further data are available, combination therapy is recommended. However, which antimicrobial combination is superior has yet to be established.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

GL carried out the systematic review, performed the analysis, and drafted the manuscript. DB participated in the design and helped to draft the manuscript. Both authors read and approved the final manuscript.

References 73

  1. 1.

    Gaynes RP Culver DH Resistance to imipenem among selected gram-negative bacilli in the United StatesInfect Control Hosp Epidemiol1992 1311014

    Not in our library10.1086/646417

  2. 2.

    Yigit H Queenan AM Anderson GJ Domenech-Sanchez A Biddle JW Steward CD Alberti S Bush K Tenover F Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniaeAntimicrob Agents Chemother2001 45411511161

    Not in our library10.1128/aac.45.4.1151-1161.2001

  3. 3.

    Arnold RS Thom KA Sharma S Phillips M Kristie Johnson J Morgan DJ Emergence of Klebsiella pneumoniae carbapenemase-producing bacteriaSouth Med J2011 10414045

    Not in our library10.1097/smj.0b013e3181fd7d5a

  4. 4.

    Endimiani A Hujer AM Perez F Bethel CR Hujer KM Kroeger J Oethinger M Paterson D Adams M Jacobs M Diekema D Hall G Jenkins S Rice L Tenover F Bonomo R Characterization of blaKPC-containing Klebsiella pneumoniae isolates detected in different institutions in the eastern USAJ Antimicrob Chemother2009 633427437

    Not in our library10.1093/jac/dkn547

  5. 5.

    Castanheira M Sader HS Deshpande LM Fritsche TR Jones RN Antimicrobial activities of tigecycline and other broad-spectrum antimicrobials tested against serine carbapenemase- and metallo-beta-lactamase-producing enterobacteriaceae: Report from the SENTRY antimicrobial surveillance programAntimicrob Agents Chemother2008 522570573

    Not in our library10.1128/aac.01114-07

  6. 6.

    Bratu S Landman D Haag R Recco R Eramo A Alam M Quale J Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: A new threat to our antibiotic armamentariumArch Intern Med2005 1651214301435

    Not in our library10.1001/archinte.165.12.1430

  7. 7.

    Gasink LB Edelstein PH Lautenbach E Fishman NO Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniaeInfect Control Hosp Epidemiol2009 301211801185

    Not in our library10.1086/648451

  8. 8.

    Souli M Galani I Antoniadou A Papadomichelakis E Poulakou G Panagea T Vourli S Zerva L Armaganidis A Kanellakopoulou K Giamarellou H An outbreak of infection due to beta-lactamase Klebsiella pneumoniae carbapenemase 2-producing K. pneumoniae in a Greek university hospital: Molecular characterization, epidemiology, and outcomesClin Infect Dis2010 503364373

    Not in our library10.1086/649865

  9. 9.

    Steinmann J Kaase M Gatermann S Popp W Steinmann E Damman M Paul A Saner F Buer J Rath P Outbreak due to a Klebsiella pneumoniae strain harbouring KPC-2 and VIM-1 in a German university hospital, July 2010 to January 2011Euro Surveill2011 163319944

    Not in our library

  10. 10.

    Nadkarni AS Schliep T Khan L Zeana CB Cluster of bloodstream infections caused by KPC-2 carbapenemase-producing Klebsiella pneumoniae in ManhattanAm J Infect Control2009 372121126

    Not in our library10.1016/j.ajic.2007.10.013

  11. 11.

    Maltezou HC Giakkoupi P Maragos A Bolikas M Raftopoulos V Papahatzaki H Vrouhos G Liakou V Vatopoulos A Outbreak of infections due to KPC-2-producing Klebsiella pneumoniae in a hospital in Crete (Greece)J Infect2009 583213219

    Not in our library10.1016/j.jinf.2009.01.010

  12. 12.

    Babouee B Widmer AF Dubuis O Ciardo D Droz S Betsch BY Garzoni C Fuhrer U Battegay M Frei R Goldenberger D Emergence of four cases of KPC-2 and KPC-3-carrying Klebsiella pneumoniae introduced to Switzerland, 2009–10Bull Europeen European Commun Dis Bull2011 1611pii=19817. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19817

    Not in our library10.2807/ese.16.11.19817-en

  13. 13.

    Tsakris A Themeli-Digalaki K Poulou A Vrioni G Voulgari E Koumaki V Agodi A Pournaras S Sofianou D Comparative evaluation of combined-disk tests using different boronic acid compounds for detection of Klebsiella pneumoniae carbapenemase-producing enterobacteriaceae clinical isolatesJ Clin Microbiol2011 49828042809

    Not in our library10.1128/jcm.00666-11

  14. 14.

    Hirsch EB Chang KT Lasco TM Caeiro JP Tam VH Emergence of KPC-producing Klebsiella pneumoniae in TexasDiagn Microbiol Infect Dis2011 692234235

    Not in our library10.1016/j.diagmicrobio.2010.09.003

  15. 15.

    Chung KP Tseng SP Huang YT Tsai TH Teng LJ Hsueh PR Arrival of Klebsiella pneumoniae carbapenemase (KPC)-2 in TaiwanJ Antimicrob Chemother2011 66511821184

    Not in our library10.1093/jac/dkr025

  16. 16.

    Bradford PA Bratu S Urban C Visalli M Mariano N Landman D Rahal JJ Brooks S Cebular S Quale J Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 beta-lactamases in New York CityClin Infect Dis2004 3915560

    Not in our library10.1086/421495

  17. 17.

    Gomez-Gil MR Pano-Pardo JR Romero-Gomez MP Gasior M Lorenzo M Quiles I Mingorance J Detection of KPC-2-producing Citrobacter freundii isolates in SpainJ Antimicrob Chemother2010 651226952697

    Not in our library10.1093/jac/dkq352

  18. 18.

    Villegas MV Lolans K Correa A Kattan JN Lopez JA Quinn JP Colombian Nosocomial Resistance Study GroupFirst identification of Pseudomonas aeruginosa isolates producing a KPC-type carbapenem-hydrolyzing beta-lactamaseAntimicrob Agents Chemother2007 51415531555

    Not in our library10.1128/aac.01405-06

  19. 19.

    Naas T Cuzon G Babics A Fortineau N Boytchev I Gayral F Nordmann P Endoscopy-associated transmission of carbapenem-resistant Klebsiella pneumoniae producing KPC-2 beta-lactamaseJ Antimicrob Chemother2010 65613051306

    Not in our library10.1093/jac/dkq117

  20. 20.

    Barbier F Ruppe E Giakkoupi P Wildenberg L Lucet J Vatopoulos A Wolff M Andremont A Genesis of a KPC-producing Klebsiella pneumoniae after in vivo transfer from an imported Greek strainBull Europeen European Commun Dis Bull2010 151pii=19457. Available online: http//www.eurosurveillance.org/ViewArticle.aspx?Articleid=19457

    Not in our library10.2807/ese.15.01.19457-en

  21. 21.

    Sidjabat HE Silveira FP Potoski BA Abu-Elmagd KM Adams-Haduch JM Paterson DL Doi Y Interspecies spread of Klebsiella pneumoniae carbapenemase gene in a single patientClin Infect Dis2009 491117361738

    Not in our library10.1086/648077

  22. 22.

    Benenson S Navon-Venezia S Carmeli Y Adler A Strahilevitz J Moses AE Block C Carbapenem-resistant Klebsiella pneumoniae endocarditis in a young adult. successful treatment with gentamicin and colistinInt J Infect Dis2009 135e295e298

    Not in our library10.1016/j.ijid.2009.01.006

  23. 23.
    Clinical and microbiological characterization of KPCproducing Klebsiella pneumoniae infections in Brazil · 2011
    Not checked
  24. 24.

    Mathers AJ Cox HL Bonatti H Kitchel B Brassinga AK Wispelwey B Sawyer RG Pruett TL Hazen KC Patel JB Sifri CD Fatal cross infection by carbapenem-resistant Klebsiella in two liver transplant recipientsTranspl Infect Dis2009 113257265

    Not in our library10.1111/j.1399-3062.2009.00374.x

  25. 25.

    Endimiani A Depasquale JM Forero S Perez F Hujer AM Roberts-Pollack D Fiorella PD Pickens N Kitchel B Casiano-Colon AE Tenover FC Bonomo RA Emergence of blaKPC-containing Klebsiella pneumoniae in a long-term acute care hospital: A new challenge to our healthcare systemJ Antimicrob Chemother2009 64511021110

    Not in our library10.1093/jac/dkp327

  26. 26.

    Lopez JA Correa A Navon-Venezia S Correa AL Torres JA Briceno DF Montealegre MC Quinn JP Carmeli Y Villegas MV Intercontinental spread from Israel to Colombia of a KPC-3-producing Klebsiella pneumoniae strainClin Microbiol Infect2011 1715256

    Not in our library10.1111/j.1469-0691.2010.03209.x

  27. 27.

    Pournaras S Vrioni G Neou E Dendrinos J Dimitroulia E Poulou A Tsakris A Activity of tigecycline alone and in combination with colistin and meropenem against Klebsiella pneumoniae carbapenemase (KPC)-producing enterobacteriaceae strains by time-kill assayInt J Antimicrob Agents2011 373244247

    Not in our library10.1016/j.ijantimicag.2010.10.031

  28. 28.

    Bratu S Tolaney P Karumudi U Quale J Mooty M Nichani S Landman D Carbapenemase-producing Klebsiella pneumoniae in Brooklyn, NY: Molecular epidemiology and in vitro activity of polymyxin B and other agentsJ Antimicrob Chemother2005 561128132

    Not in our library10.1093/jac/dki175

  29. 29.

    Pankey GA Ashcraft DS Detection of synergy using the combination of polymyxin B with either meropenem or rifampin against carbapenemase-producing Klebsiella pneumoniaeDiagn Microbiol Infect Dis2011 704561564

    Not in our library10.1016/j.diagmicrobio.2011.05.003

  30. 30.

    Lee J Patel G Huprikar S Calfee DP Jenkins SG Decreased susceptibility to polymyxin B during treatment for carbapenem-resistant Klebsiella pneumoniae infectionJ Clin Microbiol2009 47516111612

    Not in our library10.1128/jcm.02466-08

  31. 31.

    Falagas ME Rafailidis PI Ioannidou E Alexiou VG Matthaiou DK Karageorgopoulos DE Kapaskelis A Nikita D Michalopoulos A Colistin therapy for microbiologically documented multidrug-resistant gram-negative bacterial infections: A retrospective cohort study of 258 patientsInt J Antimicrob Agents2010 352194199

    Not in our library10.1016/j.ijantimicag.2009.10.005

  32. 32.

    Samonis G Matthaiou DK Kofteridis D Maraki S Falagas ME In vitro susceptibility to various antibiotics of colistin-resistant gram-negative bacterial isolates in a general tertiary hospital in Crete, GreeceClin Infect Dis2010 501216891691

    Not in our library10.1086/653009

  33. 33.

    Matthaiou DK Michalopoulos A Rafailidis PI Karageorgopoulos DE Papaioannou V Ntani G Samonis G Falagas ME Risk factors associated with the isolation of colistin-resistant gram-negative bacteria: A matched case–control studyCrit Care Med2008 363807811

    Not in our library10.1097/ccm.0b013e3181652fae

  34. 34.

    Toth A Damjanova I Puskas E Janvari L Farkas M Dobak A Borocz K Paszti J Emergence of a colistin-resistant KPC-2-producing Klebsiella pneumoniae ST258 clone in HungaryEur J Clin Microbiol Infect Dis2010 297765769

    Not in our library10.1007/s10096-010-0921-3

  35. 35.

    Zarkotou O Pournaras S Voulgari E Chrysos G Prekates A Voutsinas D Themeli-Digalaki K Tsakris A Risk factors and outcomes associated with acquisition of colistin-resistant KPC-producing Klebsiella pneumoniae: A matched case–control studyJ Clin Microbiol2010 48622712274

    Not in our library10.1128/jcm.02301-09

  36. 36.

    Humphries RM Kelesidis T Dien Bard J Ward KW Bhattacharya D Lewinski MA Successful treatment of pan-resistant Klebsiella pneumoniae pneumonia and bacteraemia with a combination of high-dose tigecycline and colistinJ Med Microbiol2010 5913831386

    Not in our library10.1099/jmm.0.023010-0

  37. 37.

    Neonakis IK Samonis G Messaritakis H Baritaki S Georgiladakis A Maraki S Spandidos DA Resistance status and evolution trends of Klebsiella pneumoniae isolates in a university hospital in Greece: Ineffectiveness of carbapenems and increasing resistance to colistinChemotherapy2010 566448452

    Not in our library10.1159/000320943

  38. 38.

    Bogdanovich T Adams-Haduch JM Tian GB Nguyen MH Kwak EJ Muto CA Doi Y Colistin-resistant, Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae belonging to the international epidemic clone ST258Clin Infect Dis2011 534373376

    Not in our library10.1093/cid/cir401

  39. 39.

    Jernigan MG Press EG Nguyen MH Clancy CJ Shields RK The combination of doripenem and colistin is bactericidal and synergistic against colistin-resistant, carbapenemase-producing Klebsiella pneumoniaeAntimicrob Agents Chemother2012 56633953398

    Not in our library10.1128/aac.06364-11

  40. 40.

    Weisenberg SA Morgan DJ Espinal-Witter R Larone DH Clinical outcomes of patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae after treatment with imipenem or meropenemDiagn Microbiol Infect Dis2009 642233235

    Not in our library10.1016/j.diagmicrobio.2009.02.004

  41. 41.

    Goldfarb D Harvey SB Jessamine K Jessamine P Toye B Desjardins M Detection of plasmid-mediated KPC-producing Klebsiella pneumoniae in Ottawa, Canada: Evidence of intrahospital transmissionJ Clin Microbiol2009 47619201922

    Not in our library10.1128/jcm.00098-09

  42. 42.

    Leao RS Carvalho-Assef AP Correal JC Silva RV Goldemberg DC Asensi MD Marques EA KPC-2 producing Klebsiella pneumoniae and Escherichia coli co-infection in a catheter-related infectionClin Microbiol Infect2011 173380382

    Not in our library10.1111/j.1469-0691.2010.03268.x

  43. 43.

    Rhee JY Park YK Shin JY Choi JY Lee MY Peck KR Song JH Ko KS KPC-producing extreme drug-resistant Klebsiella pneumoniae isolate from a patient with diabetes mellitus and chronic renal failure on hemodialysis in South KoreaAntimicrob Agents Chemother2010 54522782279

    Not in our library10.1128/aac.00011-10

  44. 44.

    Akpaka PE Swanston WH Ihemere HN Correa A Torres JA Tafur JD Montealegre MC Quinn JP Villegas MV Emergence of KPC-producing Pseudomonas aeruginosa in Trinidad and TobagoJ Clin Microbiol2009 47826702671

    Not in our library10.1128/jcm.00362-09

  45. 45.

    Mendes RE Bell JM Turnidge JD Yang Q Yu Y Sun Z Jones RN Carbapenem-resistant isolates of Klebsiella pneumoniae in china and detection of a conjugative plasmid (blaKPC-2 plus qnrB4) and a blaIMP-4 geneAntimicrob Agents Chemother2008 522798799

    Not in our library10.1128/aac.01185-07

  46. 46.

    Villegas MV Lolans K Correa A Suarez CJ Lopez JA Vallejo M Quinn JP Colombian Nosocomial Resistance Study GroupFirst detection of the plasmid-mediated class A carbapenemase KPC-2 in clinical isolates of Klebsiella pneumoniae from South AmericaAntimicrob Agents Chemother2006 50828802882

    Not in our library10.1128/aac.00186-06

  47. 47.

    Le J Castanheira M Burgess DS McKee B Iqbal R Jones RN Clonal dissemination of Klebsiella pneumoniae carbapenemase KPC-3 in Long Beach, CaliforniaJ Clin Microbiol2010 482623625

    Not in our library10.1128/jcm.02397-09

  48. 48.

    Endimiani A Carias LL Hujer AM Bethel CR Hujer KM Perez F Hutton RA Fox WR Hall GS Jacobs MR Paterson DL Rice LB Jenkins SG Tenover FC Bonomo RA Presence of plasmid-mediated quinolone resistance in Klebsiella pneumoniae isolates possessing blaKPC in the United StatesAntimicrob Agents Chemother2008 52726802682

    Not in our library10.1128/aac.00158-08

  49. 49.

    Wei Z Yu T Qi Y Ji S Shen P Yu Y Chen Y Coexistence of plasmid-mediated KPC-2 and IMP-4 carbapenemases in isolates of Klebsiella pneumoniae from ChinaJ Antimicrob Chemother2011 661126702671

    Not in our library10.1093/jac/dkr330

  50. 50.

    Ho VP Jenkins SG Afaneh CI Turbendian HK Nicolau DP Barie PS Use of meropenem by continuous infusion to treat a patient with a bla(kpc-2)-positive Klebsiella pneumoniae blood stream infectionSurg Infect2011 124325327

    Not in our library10.1089/sur.2010.072

  51. 51.

    Perrott J Mabasa VH Ensom MH Comparing outcomes of meropenem administration strategies based on pharmacokinetic and pharmacodynamic principles: A qualitative systematic reviewAnn Pharmacother2010 443557564

    Not in our library10.1345/aph.1m339

  52. 52.

    Craig WA Kethireddy S Andes DR Stamstad T Marchilo K Jones RN Impact of KPCs on the in vivo activity of three carbapenems in the neutropenic mouse-thigh infection model [abstract]. 46th Interscience Conference Antimicrobial and Agents Chemotherapy (ICAAC)2008 Washington, DC: American Society for Microbiology and Infectious Diseases Society of America

    Not in our library

  53. 53.

    Bulik CC Christensen H Li P Sutherland CA Nicolau DP Kuti JL Comparison of the activity of a human simulated, high-dose, prolonged infusion of meropenem against Klebsiella pneumoniae producing the KPC carbapenemase versus that against Pseudomonas aeruginosa in an in vitro pharmacodynamic modelAntimicrob Agents Chemother2010 542804810

    Not in our library10.1128/aac.01190-09

  54. 54.

    Clinical and Laboratory Standards Institute (CLSI)Performance standards for antimicrobial susceptibility testing: twentieth informational supplement (June 2010 update). CLSI document M100-S20-U2010 Wayne, PA, USA: Clinical and Laboratory Standards Institute

    Not in our library

  55. 55.

    Tsakris A Voulgari E Poulou A Kimouli M Pournaras S Ranellou K Kosmopoulou O Petropoulou D In vivo acquisition of a plasmid-mediated bla(KPC-2) gene among clonal isolates of Serratia marcescensJ Clin Microbiol2010 48725462549

    Not in our library10.1128/jcm.00264-10

  56. 56.

    Daly MW Riddle DJ Ledeboer NA Dunne WM Ritchie DJ Tigecycline for treatment of pneumonia and empyema caused by carbapenemase-producing Klebsiella pneumoniaePharmacotherapy2007 27710521057

    Not in our library10.1592/phco.27.7.1052

  57. 57.

    Peleg AY Potoski BA Rea R Adams J Sethi J Capitano B Husain S Kwak EJ Bhat SV Paterson DL Acinetobacter baumannii bloodstream infection while receiving tigecycline: A cautionary reportJ Antimicrob Chemother2007 591128131

    Not in our library10.1093/jac/dkl441

  58. 58.

    Meagher AK Ambrose PG Grasela TH Ellis-Grosse EJ The pharmacokinetic and pharmacodynamic profile of tigecyclineClin Infect Dis2005 41Suppl 5S333S340

    Not in our library10.1086/431674

  59. 59.

    Le J McKee B Srisupha-Olarn W Burgess DS In vitro activity of carbapenems alone and in combination with amikacin against KPC-producing Klebsiella pneumoniaeJ Clin Med Res2011 33106110

    Not in our library10.4021/jocmr551w

  60. 60.

    Nguyen M Eschenauer GA Bryan M O'Neil K Furuya EY Della-Latta P Kubin CJ Carbapenem-resistant Klebsiella pneumoniae bacteremia: Factors correlated with clinical and microbiologic outcomesDiagn Microbiol Infect Dis2010 672180184

    Not in our library10.1016/j.diagmicrobio.2010.02.001

  61. 61.

    Kelesidis T Karageorgopoulos DE Kelesidis I Falagas ME Tigecycline for the treatment of multidrug-resistant enterobacteriaceae: A systematic review of the evidence from microbiological and clinical studiesJ Antimicrob Chemother2008 625895904

    Not in our library10.1093/jac/dkn311

  62. 62.

    Hussein K Sprecher H Mashiach T Oren I Kassis I Finkelstein R Carbapenem resistance among Klebsiella pneumoniae isolates: Risk factors, molecular characteristics, and susceptibility patternsInfect Control Hosp Epidemiol2009 307666671

    Not in our library10.1086/598244

  63. 63.

    Elemam A Rahimian J Mandell W Infection with panresistant Klebsiella pneumoniae: A report of 2 cases and a brief review of the literatureClin Infect Dis2009 492271274

    Not in our library10.1086/600042

  64. 64.

    Richter SN Frasson I Bergo C Parisi S Cavallaro A Palu G Transfer of KPC-2 carbapenemase from Klebsiella pneumoniae to Escherichia coli in a patient: First case in EuropeJ Clin Microbiol2011 49520402042

    Not in our library10.1128/jcm.00133-11

  65. 65.

    Bratu S Brooks S Burney S Kochar S Gupta J Landman D Quale J Detection and spread of Escherichia coli possessing the plasmid-borne carbapenemase KPC-2 in Brooklyn, New YorkClin Infect Dis2007 447972975

    Not in our library10.1086/512370

  66. 66.

    Lo A Verrall R Williams J Stratton C Della-Latta P Tang YW Carbapenem resistance via the blaKPC-2 gene in Enterobacter cloacae blood culture isolateSouth Med J2010 1035453454

    Not in our library10.1097/smj.0b013e3181d710bf

  67. 67.

    Kuai S Huang L Pei H Chen Y Liu J Imipenem resistance due to class A carbapenemase KPC-2 in a Flavobacterium odoratum isolateJ Med Microbiol2011 6014081409

    Not in our library10.1099/jmm.0.029660-0

  68. 68.

    Bennett JW Mende K Herrera ML Yu X Lewis JS 2nd Wickes BL Jorgensen JH Murray CK Mechanisms of carbapenem resistance among a collection of enterobacteriaceae clinical isolates in a Texas cityDiagn Microbiol Infect Dis2010 664445448

    Not in our library10.1016/j.diagmicrobio.2009.11.013

  69. 69.

    Satlin MJ Kubin CJ Blumenthal JS Cohen AB Furuya EY Wilson SJ Jenkins SG Calfee DP Comparative effectiveness of aminoglycosides, polymyxin B, and tigecycline for clearance of carbapenem-resistant Klebsiella pneumoniae from the urineAntimicrob Agents Chemother2011 5558935899

    Not in our library10.1128/aac.00387-11

  70. 70.

    Alexander BT Marschall J Tibbetts RJ Neuner EA Dunne MW Ritchie DJ Treatment and clinical outcomes of urinary tract infections caused by KPC-producing Enterobacteriaceae in a retrospective cohortClin Ther2012 34613141323

    Not in our library10.1016/j.clinthera.2012.05.002

  71. 71.

    Qureshi ZA Paterson DL Potoski BA Kilayko MC Sandovsky G Sordillo E Polsky B Adams-Haduch JM Doi Y Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: Superiority of combination antimicrobial regimensAntimicrob Agents Chemother2012 56421082113

    Not in our library10.1128/aac.06268-11

  72. 72.

    Tumbarello M Viale P Viscoli C Trecarichi EM Tumietto F Marchese A Spanu T Ambretti S Ginocchio F Cristini F Losito AR Tedeschi S Cauda R Bassetti M Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: Importance of combination therapyClin Infect Dis2012 557943950

    Not in our library10.1093/cid/cis588

  73. 73.

    Hirsch EB Tam VH Detection and treatment options for Klebsiella pneumoniae carbapenemases (KPCs): An emerging cause of multidrug-resistant infectionJ Antimicrob Chemother2010 65611191125

    Not in our library10.1093/jac/dkq108

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