Optimizing therapy for infections caused by enterobacteriaceae producing extended-spectrum beta-lactamases

Endimiani, Andrea and Paterson, David L. (2007) Optimizing therapy for infections caused by enterobacteriaceae producing extended-spectrum beta-lactamases. Seminars in Respiratory and Critical Care Medicine: pulmonology, critical care, allergy and immunology infections, 28 6: 646-655. doi:10.1055/s-2007-996411


Author Endimiani, Andrea
Paterson, David L.
Title Optimizing therapy for infections caused by enterobacteriaceae producing extended-spectrum beta-lactamases
Journal name Seminars in Respiratory and Critical Care Medicine: pulmonology, critical care, allergy and immunology infections   Check publisher's open access policy
ISSN 1069-3424
Publication date 2007-12
Sub-type Article (original research)
DOI 10.1055/s-2007-996411
Volume 28
Issue 6
Start page 646
End page 655
Total pages 10
Editor J. P. Lynch
Place of publication New York, N.Y. U.S.A.
Publisher Thieme Medical Publishers
Collection year 2008
Language eng
Subject 321010 Infectious Diseases
C1
730101 Infectious diseases
Abstract The spread of multidrug-resistant Enterobacteriaceae is complicating the treatment of nosocomial infections. In many parts of the world, resistance to third-generation cephalosporins exceeds 10% of total nosocomial isolates and 30% of isolates detected in the intensive care unit. This resistance is frequently due to the acquisition of plasmids containing genes encoding for extended-spectrum β-lactamases (ESBLs). Furthermore, these mobile elements often carry genes encoding resistance to other drugs such as aminoglycosides. A high risk of poor clinical outcome has been observed in patients infected with ESBL producers receiving third-generation cephalosporins, even if the organism appears susceptible to the antibiotic. For this reason, clinical microbiology laboratories are advised to incorporate specific ESBL detection methodology into routine clinical practice. This should prevent erroneous use of cephalosporins for these infections. Most ESBL producers remain susceptible to carbapenems, and these agents are considered the drugs of choice against ESBL-producing organisms. Unfortunately, there is now an increasing occurrence of carbapenem resistance in the Enterobacteriaceae. In this context, clinical response to new antibiotics (e.g., tigecycline) and old antibiotics (e.g., colistin) with good in vitro activity against ESBL producers needs to be evaluated. Copyright © 2007 by Thieme Medical Publishers, Inc.
Keyword Beta-lactams
ICU
Epidemiology
Outcome
Therapy
Blood-stream Infections
Outer-membrane Protein
In-vitro Activity
Escherichia-coli
Risk-factors
Piperacillin-tazobactam
Q-Index Code C1
Q-Index Status Confirmed Code

 
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Created: Tue, 29 Apr 2008, 11:51:59 EST by Sarah Elliott on behalf of Medicine - Royal Brisbane and Women's Hospital