Antimicrobial stewardship strategies against extended-spectrum β-lactamase-carrying enterobacterales: a review

Rovira i Plujà, Jana

Antimicrobial stewardship strategies against extended-spectrum β-lactamase-carrying enterobacterales: a review

Citation

Rovira i Plujà, J. Antimicrobial stewardship strategies against extended-spectrum β-lactamase-carrying enterobacterales: a review. 2021. handle: http://hdl.handle.net/10230/46880

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Abstract

Multidrug-resistant and extremely-drug resistant (MDR/XDR) Gram-negative bacteria (GNB) are responsible of most healthcare-associated infections worldwide. Antimicrobial stewardship (AMS) and infection control strategies have been implemented to improve antibiotic use and reduce the emergence of resistance. Extended-spectrum β-lactamases (ESBLs) are the main β-lactam resistance mechanism in GNB. The aim of this review was to evaluate the current knowledge of ESBL-carrying Enterobacterales within the framework of AMS, especially focusing on the situation in Spain. Rapid identification of MDR/XDR bacteria is essential to improve targeted-treatment. Carbapenems are the most common antibiotics used to treat ESBL infections despite their huge ecological impact. In this context, several carbapenem-spare treatments have been proposed in the recent years. Combinations of β-lactam/β-lactamase inhibitors may be suitable to treat urinary tract infections but their use in severe infections is controversial. Some new antibacterial drugs seem a good alternative to treat severe infections, but their use should be preserved through AMS strategies. Fluoroquinolones have been associated to the global spread of ESBL-carrying high-risk clones. These antibiotics are widely used both in humans and in food-producing animals, and the consumption in Spain is high. A reduction in fluoroquinolones prescription would be another AMS strategy to reduce the clonal expansion of MDR/XDR high-risk clones. The implementation of AMS strategies aims to have a positive impact to diminish the spread of resistance.