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Therapeutic Challenges Associated with Extended‐Spectrum, β‐Lactamase‐Producing Escherichia coli and Klebsiella pneumoniae
Author(s) -
WongBeringer Annie
Publication year - 2001
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.21.6.583.34537
Subject(s) - aztreonam , klebsiella pneumoniae , cephalosporin , imipenem , microbiology and biotechnology , enterobacteriaceae , antibiotics , medicine , beta lactamase , klebsiella , biology , escherichia coli , antibiotic resistance , gene , biochemistry
The emergence of extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae, particularly Escherichia coli and Klebsiella pneumoniae , presents significant diagnostic and therapeutic challenges to the management of infections due to these organisms. Detection of resistant isolates is difficult based on routine susceptibility testing performed by a clinical microbiology laboratory. In addition, the utility of penicillins, cephalosporins, and aztreonam in treating serious infections due to these organisms is uncertain due to reports of treatment failure despite apparent in vitro susceptibility. A critical evaluation of the English literature was performed on treatment outcomes associated with ESBL‐producing Enterobacteriaceae. Imipenem and extended‐spectrum cephalosporins were commonly administered. Discordant outcomes in relation to in vitro susceptibility of the agent did not occur exclusively with cephalosporins but with all drugs including imipenem. Until more outcome data are available, drug selection must take into consideration whether or not an outbreak is occurring and whether therapy is empirical or definitive.