An infection caused by an extended-spectrum beta-lactamase (ESBL) producing bacteria can be difficult to treat. Inappropriate antibiotic therapy can be fatal for the patient.
Features:
(1) positive for beta-lactamase
(2) multi-drug resistance (but less than extreme drug resistance)
Resistance is seen to therapy with:
(1) all penicillins
(2) all cephalosporins (except cephamycins)
(3) variable to fluoroquinolones
(4) variable to trimethroprim-sulfamethoxazole
(5) variable to aminoglycosides
Recommendations:
(1) Perform antibiotic susceptibility testing on all isolates.
(2) Initial therapy may include a carbapenem (ertapenem). A beta-lactam combined with a beta-lactamase inhibitor may work but response is variable.
(3) The response of the patient to therapy needs to be carefully monitored.
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