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CPE — SCE Infectious Diseases MCQ

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HardAntimicrobial StewardshipCPESCE Infectious Diseases

A hospital microbiology laboratory isolates a carbapenemase-producing Klebsiella pneumoniae (KPC-type) from a patient's urine. The organism is resistant to all beta-lactams including Meropenem (MIC 16 mg/L), resistant to Ciprofloxacin and Gentamicin, but sensitive to Colistin (MIC 1 mg/L) and Ceftazidime/Avibactam (MIC 2 mg/L). The patient has a complicated urinary tract infection with bacteraemia. What is the most appropriate antibiotic?

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Correct answer: A — Ceftazidime/Avibactam IV

Ceftazidime/Avibactam has potent activity against KPC-producing Enterobacterales and achieves excellent urinary and systemic concentrations. It is now the treatment of choice for KPC-producing infections when susceptible, with superior outcomes to Colistin-based regimens in clinical studies. Colistin is nephrotoxic and has poor outcomes for bacteraemia. Tigecycline achieves poor urinary concentrations and is not suitable for UTIs or bacteraemia. High-dose Meropenem extended infusion may be considered for MICs of 4–8 mg/L but is unlikely to be effective at MIC 16 mg/L.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections