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(Chest. 2001;119:391S-396S.)
© 2001 American College of Chest Physicians

Evolution and Clinical Importance of Extended-Spectrum ß-Lactamases*

Louis Rice, MD

* From the Cleveland Veterans’ Affairs Medical Center, Cleveland, OH.

Correspondence to: Louis Rice, MD, Medical Service III (w), Cleveland Veterans’ Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106

In the process of evolution, bacteria have acquired well-developed mechanisms of resistance to an extensive array of hostile substances. This time-tempered system of defense is so intricate and adaptable that contemporary medicine has been hard-pressed to maintain an advantage. In this article, the processes responsible for bacterial resistance to extended-spectrum cephalosporins are reviewed. Particular emphasis is placed on the extended-spectrum ß-lactamases that have emerged to provide bacteria with formidable resistance to modern drugs. Avoidance of this problem requires limitations on extended-spectrum cephalosporin usage. While carbapenems are clearly the treatment of choice for infections caused by these pathogens, empirical use of ß-lactam/ß-lactamase inhibitors such as piperacillin/tazobactam has been associated with reduction in the prevalence of cephalosporin resistance.

Key Words: bacteria • ß-lactamases • carbapenems • cephalosporin resistance • resistance, ß-lactam




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E. M. Graffunder, K. E. Preston, A. M. Evans, and R. A. Venezia
Risk factors associated with extended-spectrum {beta}-lactamase-producing organisms at a tertiary care hospital
J. Antimicrob. Chemother., July 1, 2005; 56(1): 139 - 145.
[Abstract] [Full Text] [PDF]


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