ESBL Enterobacterales

ESBL Enterobacterales


General Information

Cystitis: nitrofurantoin, fosfomycin 

Complicated UTI or pyelonephritis AND confirmed susceptibility: sulfamethoxazole/trimethoprim, ciprofloxacin, levofloxacin 

Infection outside of the urinary tract: meropenem

Cystitis AND confirmed susceptibility:

  • Sulfamethoxazole/trimethoprim 
  • Ciprofloxacin 
  • Levofloxacin 
  • Single-dose gentamicin 

Complicated UTI or pyelonephritis: meropenem 

Infections outside of the urinary tract: ceftolozane/tazobactam

If confirmed susceptibility:

  • Ciprofloxacin
  • Levofloxacin

Gram-negative rods

  • Normal GI flora that have a plasmid encoding ESBL
  • Infections commonly nosocomial, but may be community-acquired, especially in patients with recent antimicrobial exposure

See individual organisms

  • ESBLs vs. AmpC: Most ESBLs are plasmid-encoded, whereas AmpCs are usually inducible and chromosomal

  • In the lab, ESBLs test susceptible to cefoxitin and may be inhibited by beta-lactamase inhibitors in vitro