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Control of Outbreaks Due to Organism Producing Extended-Spectrum -Lactamases

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To the Editor: The optimal approach to controlling an outbreak of organisms producing extended-spectrum -lactamases (ESBLs) remains unclear. Dr Rahal and colleagues¹ noted that restriction of all cephalosporins produced a 44% reduction in ceftazidime-resistant Klebsiella but resulted in a 69% increase in imipenem-resistant Pseudomonas aeruginosa. This report provides several important insights into the difficulty of addressing such outbreaks.

First, the agent used to replace late-generation cephalosporins for empirical therapy may have profound consequences in eliciting new patterns of resistance. The selection of imipenem in this study is of concern since it is often reserved as an agent of last resort, because similar prior interventions at the same institution resulted in the emergence of imipenem-resistant Acinetobacter infections,² and because of the probable significant economic impact of the intervention. Although imipenem likely was chosen because it remained active against ESBL-producing organisms, it is unclear whether the extent of the outbreak warranted . . . [Full Text of this Article]

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