From the Guidelines
The management of ESBL-producing organisms in urine should prioritize ertapenem 1 g q24h as the first-line treatment, based on the most recent and highest quality evidence available 1.
Key Considerations
- The choice of antibiotic should be guided by susceptibility testing, as ESBL organisms are resistant to most penicillins, cephalosporins, and aztreonam.
- Infection control measures, including contact precautions, hand hygiene, and environmental cleaning, are crucial to prevent transmission.
- Patients should complete the full course of antibiotics even if symptoms improve, and follow-up urine cultures may be necessary to confirm eradication.
Treatment Options
- Ertapenem 1 g q24h is the recommended first-line treatment for serious ESBL infections, as per the Italian Council for the Optimization of Antimicrobial Use guidelines 1.
- Alternative options, such as eravacycline 1 mg/kg q12h, may be considered in certain cases, but the evidence for these alternatives is not as strong as for ertapenem.
Evidence Review
- The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli provide additional context and support for the use of carbapenems, such as ertapenem, in the treatment of ESBL-producing organisms 1.
- However, the most recent and highest quality evidence available prioritizes ertapenem 1 g q24h as the first-line treatment, and this recommendation should be followed in clinical practice.
From the Research
ESBL in Urine Management
- ESBL-producing Enterobacteriaceae are a growing concern in urinary tract infections (UTIs) due to limited treatment options 2, 3, 4.
- The production of beta-lactamases is the most important mechanism of resistance to beta-lactam antibiotics, especially in Gram-negative bacteria 3.
- Risk factors for infection and colonization by ESBL producers include prolonged hospital stays, invasive devices, prior use of antibiotics, and stays in residential care 3.
Treatment Options
- Carbapenems are usually regarded as the antibiotics of choice for the treatment of serious ESBL infections, but their indiscriminate use should be avoided 5, 3.
- For uncomplicated lower urinary tract infections, fosfomycin and nitrofurantoin are the best treatment alternatives 3, 4.
- Other treatment options for UTIs due to ESBL-producing Enterobacteriaceae include:
- More than 95% of all ESBL-producing Enterobacteriaceae were sensitive to pivmecillinam, fosfomycin, and nitrofurantoin 4.
Prevention Strategies
- Prevention programs should focus on preventing nosocomial infection 3.
- A restrictive policy on the use of antibiotics should be implemented to prevent the spread of ESBL-producing organisms 3.
- Therapeutic decisions should be based on an understanding of the local distribution of microorganisms and their resistance patterns 3.