A male presenting with respiratory distress is put on a ventilator. Tracheal culture was obtained and sent for diagnosis. In the meanwhile, he was empirically staed on amikacin and ceftriaxone. Culture repo after 48 hrs shows growth of Klebsiella pneumoniae which is ESBL +ve on antimicrobial susceptibility testing. The modification needed in his antibiotic treatment is:
ESBL +ve Klebsiella pneumoniae is resistant to cephalosporins, aminoglycosides, tetracyclines, and TMP-SMX. It is sensitive to amikacin or carbapenems. Ref: Russo T.A., Johnson J.R. (2012). Chapter 149. Diseases Caused by Gram-Negative Enteric Bacilli. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
Replace ceftriaxone with ceftazidime
Omit amikacin and add a quinolone
Replace ceftriaxone with imipenem
Continue the same antibiotics at higher doses