Treatment Approach for Recurrent Klebsiella Infection with Possible Occult Enterococcus

Primary Treatment Regimen

The American College of Emergency Physicians recommends ceftazidime-avibactam (2.5g IV every 8 hours) combined with ampicillin (2g IV every 6 hours) for 4-6 weeks for patients with recurrent Klebsiella infection and possible occult Enterococcus 1
The Infectious Diseases Society of America suggests that Enterococci are intrinsically resistant to cephalosporins, and ceftazidime-avibactam alone will not cover Enterococcus 2
The Clinical Infectious Diseases society recommends a minimum of 4 weeks, preferably 6 weeks, of IV combination therapy for patients with recurrent Klebsiella infection and possible occult Enterococcus 4

The World Journal of Emergency Surgery recommends meropenem 1g IV every 8 hours + ampicillin 2g IV every 6 hours as an alternative regimen for carbapenem-susceptible Klebsiella 1
The Clinical Infectious Diseases society recommends replacing ampicillin with daptomycin 6-8 mg/kg IV every 24 hours if vancomycin-resistant Enterococcus is suspected 4

The American College of Radiology recommends urgent evaluation for undrained abscess or fluid collection, foreign body, and fistula formation in patients with recurrent Klebsiella infection 3
The Clinical Infectious Diseases society recommends repeat cultures after 48-72 hours of therapy to document clearance 4

The Clinical Microbiology and Infection society recommends oral fluoroquinolone (ciprofloxacin 500-750mg twice daily) for Klebsiella suppression if susceptible 6
The Clinical Microbiology and Infection society recommends adding amoxicillin 500mg three times daily for Enterococcal coverage 6

The Clinical Infectious Diseases society recommends blood cultures every 48-72 hours until clearance 4
The Clinical Microbiology and Infection society recommends weekly CBC, CMP, and inflammatory markers (CRP, ESR) 6