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Review

Extended-Spectrum β-Lactamases: a Clinical Update

David L. Paterson, Robert A. Bonomo
David L. Paterson
1Infectious Disease Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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  • For correspondence: patersond@dom.pitt.edu
Robert A. Bonomo
2Infectious Disease Division, Louis Stokes VA Medical Center, Cleveland, Ohio
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DOI: 10.1128/CMR.18.4.657-686.2005
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    FIG. 1.

    Explosion of knowledge on extended-spectrum β-lactamases.

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  • TABLE 1.

    Infection control interventions appropriate to controlling spread of ESBL-producing organisms within a hospital

    Identify patients infected with ESBL-producing organisms by use of appropriate detection methods in the clinical microbiology laboratory
    Identify colonized patients by use of rectal swabs plated onto selective media
    Perform molecular epidemiologic analysis of strains from infected or colonized patients (for example, by use of pulsed-field gel electrophoresis)
    Institute contact isolation precautions, particularly if clonal spread is demonstrated
    Institute controls on antibiotic use, particularly if numerous strain types are demonstrated
  • TABLE 2.

    Comparison of national MIC breakpoints for Enterobacteriaceae

    CountryMIC breakpointa (μg/ml)
    CefotaximeCeftazidime
    S (≤)R (≥)S (≤)R (≥)
    United States of America (CLSI)864832
    United Kingdom1224
    France432432
    The Netherlands416416
    Germany28432
    Spain1818
    Norway216216
    Sweden432416
    • ↵ a S, susceptible; R, resistant.

  • TABLE 3.

    Recommended treatment for infections with ESBL-producing organisms

    Infection typeTherapy of choiceSecond-line therapy
    Urinary tract infectionQuinoloneaAmoxicillin/clavualante
    BacteremiaCarbapenemQuinolonea
    Hospital-acquired pneumoniaCarbapenemQuinolonea
    Intra-abdominal infectionCarbapenemQuinolonea (plus metronidazole)
    MeningitisMeropenemIntrathecal polymyxin B
    • ↵ a If the organism is quinolone susceptible.

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Extended-Spectrum β-Lactamases: a Clinical Update
David L. Paterson, Robert A. Bonomo
Clinical Microbiology Reviews Oct 2005, 18 (4) 657-686; DOI: 10.1128/CMR.18.4.657-686.2005

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Extended-Spectrum β-Lactamases: a Clinical Update
David L. Paterson, Robert A. Bonomo
Clinical Microbiology Reviews Oct 2005, 18 (4) 657-686; DOI: 10.1128/CMR.18.4.657-686.2005
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  • Top
  • Article
    • SUMMARY
    • INTRODUCTION
    • DEFINITION OF EXTENDED-SPECTRUM β-LACTAMASES
    • DIVERSITY OF ESBL TYPES
    • EPIDEMIOLOGY OF ESBL-PRODUCING ORGANISMS
    • INFECTION CONTROL IMPLICATIONS OF ESBL-PRODUCING ORGANISMS
    • DETECTION OF ESBLs IN THE CLINICAL MICROBIOLOGY LABORATORY
    • TREATMENT AND OUTCOME OF INFECTIONS WITH ESBL-PRODUCING ORGANISMS
    • CONCLUSIONS
    • ACKNOWLEDGMENTS
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

KEYWORDS

Enterobacteriaceae
Plasmids
beta-Lactamases

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