Recommendation for treatment of severe infections caused by Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs)

Extended-spectrum beta -lactamase (ESBL)-producing organisms are a global p roblem. No randomized controlled trials have ever been performed to guide o ptimal treatment. However, in vitro studies and observational studies stron gly suggest that carbapenems (imipenem or meropenem) should be regarded as drugs of choice for serious infections due to ESBL-producing organisms. Oth er beta -lactam antibiotics (cefepime, beta -lactam/beta -lactamase inhibit or combinations) are not suitable as first-line therapy. The increasing fre quency of the association between quinolone resistance and ESBL production have greatly limited the role of this class of antibiotic against ESBL prod ucers.