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Antimicrobial Synergy Testing by the Inkjet Printer-assisted Automated Checkerboard Array and the Manual Time-kill Method
Published on: April 18, 2019
Optimizing therapy for infections caused by enterobacteriaceae producing extended-spectrum beta-lactamases
Andrea Endimiani1, David L Paterson
1Division of Infectious Diseases, University of Pittsburgh School of Medicine, 3601 5th Avenue, Pittsburgh, PA 15213, USA.
Seminars in Respiratory and Critical Care Medicine
|December 21, 2007
Summary
Multidrug-resistant Enterobacteriaceae, especially those producing extended-spectrum beta-lactamases (ESBLs), complicate hospital infections. Evaluating new and old antibiotics is crucial due to rising carbapenem resistance.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Pharmacy
Background:
- The rise of multidrug-resistant Enterobacteriaceae, particularly extended-spectrum beta-lactamase (ESBL) producers, poses a significant challenge in treating nosocomial infections globally.
- Resistance rates to third-generation cephalosporins are alarmingly high, exceeding 10% in general nosocomial isolates and 30% in intensive care units.
Purpose of the Study:
- To highlight the clinical implications of ESBL-producing Enterobacteriaceae infections.
- To emphasize the need for specific laboratory detection methods for ESBLs to guide appropriate antibiotic therapy.
- To address the growing concern of carbapenem resistance and evaluate alternative treatment options.
Main Methods:
- Review of current literature on multidrug-resistant Enterobacteriaceae and ESBL prevalence.
- Analysis of clinical outcomes associated with ESBL-producing infections.
- Discussion of antibiotic resistance mechanisms and treatment strategies.
Main Results:
- Infections with ESBL producers are linked to poor clinical outcomes, even with seemingly susceptible antibiotics like third-generation cephalosporins.
- Carbapenems are currently the preferred treatment for ESBL-producing Enterobacteriaceae, but carbapenem resistance is increasing.
- Emerging resistance necessitates the evaluation of alternative agents such as tigecycline and colistin.
Conclusions:
- Routine ESBL detection in clinical microbiology laboratories is essential to prevent inappropriate cephalosporin use.
- The increasing prevalence of carbapenem resistance requires urgent assessment of alternative therapeutic options for ESBL-producing Enterobacteriaceae infections.
- Further clinical evaluation of newer and older antibiotics against resistant strains is critical.
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