do you think we should routinely test Enterobacterales for the presence of ESBL or just base or treatment on ceftriaxone Resistance? How would you treat this UTI with bacteremia (assuming is TMP-SMX qnd FQ resistant) - ThreadSky

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idvilchez.bsky.social • 59 days ago

do you think we should routinely test Enterobacterales for the presence of ESBL or just base or treatment on ceftriaxone Resistance? How would you treat this UTI with bacteremia (assuming is TMP-SMX qnd FQ resistant)

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idvilchez.bsky.social•59 days ago

https://pubmed.ncbi.nlm.nih.gov/33987537/

infectedterran.bsky.social•59 days ago

I think you can intuit mechanism of resistance here based on Cefoxitin resistance (Likely AMP-C?). A lot of the times the abx choice will be similar though. But probably can use cefepime here.

https://academic.oup.com/cid/article/69/8/1446/5369903

dralicehan.bsky.social•58 days ago

I agree. I use cefoxitin, aztreonam, amp/sulbactam as pseudo proxy for esbl. If cefoxitin S, azt R, I treat as esbl even if pcr neg as there are other mech of Esbl R (SHV, TEM) and pcr usually only tests for ctx-m

infectedterran.bsky.social•58 days ago

sandrowolf.bsky.social•59 days ago

In uncomplicated UTIs I would go for Pip/Tazobactam or any 3rd gen Cephalosporin if tested s (irrespective of ESBL or not, that is: no ESBL testing). In more serious infections I would test for ESBL and if positive avoid penicillins and Cephalosporins and use Ciprofloxacin or a carbapenem instead.

sebpoule.bsky.social•59 days ago

Would be comfortable with Cefepime

We never test for the presence of ESBL

idvilchez.bsky.social•59 days ago

But if you don't know it is not ESBL, based on the abx susceptibility panel alone, it looks like an ESBL producer based on ceftriaxone Resistance. Would you still use cefepime?

sebpoule.bsky.social•59 days ago

possible AmpC with CFP S so yes Cefepime

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