Management of infections caused by Extended-spectrum beta-lactamase-producing Enterobacterales in Indian patients

Extended-spectrum beta-lactamases (ESBLs), particularly in Enterobacterales, are major contributors to the growing problem of antibiotic resistance in Gram-negative bacilli. This guidance document provides an overview of the epidemiology, identification, and clinical management of infections caused by Extended-Spectrum Beta-Lactamase-producing Enterobacterales (ESBL-E). This guideline adds on the previously issued Indian Council of Medical Research (ICMR) guidelines on carbapenem-resistant organisms (CROs) and intended to support clinicians in making evidence-based decisions regarding the diagnosis and treatment of ESBL infections, thereby promoting effective patient management and antimicrobial stewardship.

The purpose of this guidance document aims to assist clinicians in selecting not only the right antibiotics to diagnose ESBLs, but also right tests to diagnose ESBLs, for effective management of ESBL infections.

This guidance document highlights the importance of early and accurate identification of ESBL -producing Enterobacterales, outlines clinical syndromes that may require empirical antibiotic coverage for ESBLs, and offers guidance on appropriate de-escalation strategies. Additionally, it emphasizes on the optimal use of use of newer beta-lactam/beta-lactamase inhibitor (BLBLI) combinations, such as cefepime-enmetazobactam and ceftolozane-tazobactam, and also emphasizes on avoiding important drugs like ceftazidime-avibactam for ESBL -producing Enterobacterales.