Case Report Treatment for severe infections due to carbapenem-resistant Klebsiella pneumoniae in pediatric patients: combination of fosfomycin with carbapenems

The emergence of carbapenem-resistant Klebsiella pneumoniae is considered as a significant global public health challenge, especially in pediatric patients, since the optimal treatment remains undefined. We summarize the therapeutic experience of six cases with carbapenems-resistant Klebsiella pneumoniae infection occurred in pediatric intensive care unit. Related clinical symptoms and examinations indicated that this highly resistant gramnegative bacillus brought about pneumonia with bloodstream infection (3 cases), bloodstream infection (1 case), intra-abdominal infection (1 case), and intra-abdominal infection with bloodstream infection (1 case). The infection induced by K. pneumoniae caused aberrant expression of multiple blood indexes including white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT), neutrophils and bilirubin. Carbapenems were frequently used as the first choice such as imipenem and meropenem in all cases. Meanwhile, other antibacterial strategy was employed including amikacin, amoxicillin-clavulanate, Sulfamethoxazole and Trimethoprim and fosfomycin. Particularly, fosfomycin was frequently given with the combination of carbapenems. Clinical cure of the infection due to carbapenems-resistant Klebsiella pneumoniae was observed in all of patients who treated with combination of fosfomycin and carbapenems. In conclusion, combination strategy with fosfomycin and carbapenems should be recommended for the treatment of carbapenems-resistant K. pneumoniae infection. The clinical benefit of antibacterial regimen is limited with carbapenems alone. Combination of antibacterial agents needs to be established in the presence of accumulative and prospective clinical trials.