Comparing Carbapenems and Cephalosporin-Beta-Lactamase Combinations for Treating Carbapenemase-Producing Klebsiella Sepsis
DOI:
https://doi.org/10.56294/saludcyt20251701Keywords:
Carbapenem-resistant Klebsiella pneumoniae, Cephalosporin-beta-lactamase inhibitors, Sepsis, Antibiotic resistance, Ceftazidime-avibactam, Carbapenem therapyAbstract
Background: Carbapenemase-producing Klebsiella pneumoniae (CRKP) presents a serious global health threat, particularly in critical care settings where it significantly contributes to mortality in patients with severe sepsis. Carbapenem-based regimens, once the mainstay for Gram-negative infections, have shown declining efficacy due to growing resistance. In response, cephalosporin–beta-lactamase inhibitor (C-BLI) combinations such as ceftazidime–avibactam and cefiderocol have emerged as potential alternatives, though their clinical superiority remains uncertain.
Objective: This systematic review aims to compare the efficacy of carbapenem-based regimens versus C-BLI combinations in the treatment of severe sepsis caused by CRKP, following PRISMA guidelines.
Methods: A comprehensive search was conducted across PubMed, Embase, Scopus, and Web of Science for randomized controlled trials and cohort studies published between 2010 and 2024. Primary outcomes included 30-day mortality, microbiological clearance, and nephrotoxicity.
Results: Carbapenem-based combinations particularly those including colistin or tigecycline, were associated with reduced mortality but increased nephrotoxicity. In contrast, C-BLI regimens demonstrated better microbiological clearance and a more favorable toxicity profile. However, their efficacy against certain resistance mechanisms—especially metallo-beta-lactamases—remains limited. Agents like ceftazidime–avibactam show promise but are challenged by emerging resistance.
Conclusion: Therapeutic decisions should be individualized, considering local resistance patterns, patient comorbidities, and drug toxicities. There is an urgent need for further large-scale randomized trials to identify optimal treatment strategies for CRKP-induced severe sepsis and mitigate antibiotic resistance.
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Copyright (c) 2025 Mónica Alexandra Caiza Asitimbay, Daniel Alexander Robles Gutiérrez, Alexis Agustin Dunay Silva, Dayanna Alejandra Flores Díaz, Stephanie Daniela Gualotuña Vasco, Ronny Ricardo Olalla Alava, Dario Javier Caguate Miranda, Mauro Rubén Cushpa Guamán, Elva María Cancino Cedeño, Sandra Ivette Lopez Aguilar (Author)
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