Navigating treatment approaches for presumed ESBL-producing infections

Area of Science:

• Infectious Diseases
• Microbiology
• Pharmacology

Background:

• Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) represent a critical global health threat.
• High prevalence of ESBLs in *Escherichia coli* and *Klebsiella pneumoniae* contributes to substantial morbidity and mortality worldwide.
• Carbapenems are effective for invasive ESBL-E infections, but their necessity in all cases is debated.

Purpose of the Study:

• To debate the necessity of carbapenems for all infections caused by ceftriaxone-resistant Enterobacterales.
• To explore the potential role of carbapenem alternatives in managing ESBL-E infections.
• To address the implications of carbapenem use on the escalating antimicrobial resistance crisis.

Main Methods:

• This study presents a PRO/CON debate format.
• Expert opinions are presented regarding the treatment of ESBL-E infections.
• The debate focuses on ceftriaxone-resistant Enterobacterales.

Main Results:

• The debate highlights the controversy surrounding carbapenem use for ESBL-E infections.
• Evidence for and against carbapenem necessity in select cases is discussed.
• The potential for carbapenem alternatives is a key point of discussion.

Conclusions:

• Indiscriminate carbapenem use exacerbates the antimicrobial resistance crisis.
• Investigating non-carbapenem treatment options for ESBL-E is crucial.
• Careful consideration of treatment strategies is needed to preserve carbapenem efficacy.