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Journal of Pharmacy Practice
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Current Perspectives on Extended-Spectrum Beta-Lactamase–Producing Gram-Negative Bacilli

Brad M. Wright, PharmD

Department of Pharmacy, Huntsville Hospital, Huntsville, Alabama

Edward H. Eiland, III, PharmD, MBA, BCPS, CGP

Department of Pharmacy, Huntsville Hospital, Huntsville, Alabama, edward.eiland{at}hhsys.org

Beta-lactamase enzymes produced by gram-negative bacilli were identified before the first beta-lactam antibiotics were used to treat infections. As these enzymes adapted to available beta-lactam agents, newer beta-lactam agents were developed. Development and widespread use of the oxyimino-cephalosporins led to the emergence of extended-spectrum beta-lactamase enzymes that hydrolyze the penicillins, extended-spectrum cephalosporins, and aztreonam. There are now over 200 recognized ESBLs in a variety of gram-negative bacilli conferring resistance to penicillins, cephalosporins, a monobactam, and even carbapenems. The emergence of these enzymes is associated with poor patient outcomes, increased total health care costs, and more carbapenem use. Carbapenems should be selected judiciously to optimize outcomes while preventing further selection of extended-spectrum beta-lactamase resistance.

Key Words: extended-spectrum beta-lactamases • Escherichia coli • Klebsiella • multi-drug resistant gram-negative • carbapenem

This version was published on October 1, 2008

Journal of Pharmacy Practice, Vol. 21, No. 5, 338-345 (2008)
DOI: 10.1177/0897190008318497
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