From the Guidelines
No, ESBL E. coli would not be susceptible to vancomycin. Vancomycin is only effective against gram-positive bacteria, while E. coli is a gram-negative bacterium 1. The fundamental difference lies in their cell wall structure - gram-negative bacteria have an outer membrane that prevents vancomycin from reaching its target site, the peptidoglycan layer.
Treatment Options for ESBL E. coli
For treating ESBL (Extended-Spectrum Beta-Lactamase) producing E. coli infections, the following are potential treatment options:
- Carbapenems like meropenem, imipenem, or doripenem, as recommended for empiric therapy in cases of health care–associated complicated intra-abdominal infection where ESBL-producing Enterobacteriaceae are suspected 1
- Other potential options depending on susceptibility testing include:
- Piperacillin-tazobactam
- Ceftazidime or cefepime, each with metronidazole, as listed for ESBL-producing Enterobacteriaceae 1
- Fosfomycin
Considerations for Treatment
In some cases, aminoglycosides or fluoroquinolones might be effective, but resistance to these is common in ESBL-producing organisms. It is crucial to base treatment decisions on culture and susceptibility testing results, as resistance patterns can vary 1. The choice of antibiotic should be guided by local resistance patterns and the specific susceptibility profile of the isolated organism.
From the Research
Susceptibility of ESBL E. coli to Vancomycin
- There are no studies that directly address the susceptibility of ESBL E. coli to vancomycin 2, 3, 4, 5, 6.
- The provided studies focus on the treatment of infections caused by ESBL-producing Enterobacteriaceae, including E. coli, and discuss various antibiotic options such as carbapenems, beta-lactam/beta-lactamase inhibitor combinations, and fluoroquinolones 2, 3, 4, 5, 6.
- Vancomycin is not mentioned as a treatment option for ESBL E. coli in any of the provided studies, suggesting that it may not be effective against this type of bacteria 2, 3, 4, 5, 6.
Alternative Treatment Options
- The studies suggest that carbapenems are the most reliable antibiotics for severe infections caused by ESBL-producing Enterobacteriaceae, including E. coli 2, 3, 4, 5.
- Other treatment options, such as piperacillin/tazobactam, cefepime, and fluoroquinolones, may be effective in certain cases, but their use is limited by concerns about resistance and efficacy 2, 3, 4, 5, 6.
- Newer antibiotics, such as ceftolozane/tazobactam and ceftazidime/avibactam, have been approved for the treatment of complicated urinary tract infections and complicated intra-abdominal infections caused by ESBL-producing Enterobacteriaceae, including E. coli 5, 6.