Multiresistant Gram-negative Bacilli

Recent local, national and international surveillance has identified a worrying increase in multiple resistance to antibiotics in Gram-negative bacilli; particularly gentamicin, quinolone and cephalosporin resistant E. coli, with up to 10% resistant to gentamicin and 3rd generation cephalosporins (ESBL positive) This is of concern as E coli is the most common cause of community and hospital acquired Gram-negative sepsis.

Local surveillance has identified the following risk factors for ESBL positive E coli:

• Previous history of isolation of ESBLpositive E.coli or Multiresistant gram negative organisms OR

• Recurrent urinary or biliary tract sepsis (greater than 2 in the last year)

• Sepsis despite current or recent (within the last week) treatment with broad-spectrum antibiotics e.g. co-amoxiclav, cefuroxime, quinolones (ciprofloxacin, levofloxacin)

To enable effective management of these patients, it is therefore important that appropriate specimens (including blood cultures) are taken and their previous microbiology reviewed.

Where a multiresistant isolate has been identified previously e.g. gentamicin resistant coliform in urine, first line therapy must be discussed with a medical microbiologist, as usual first line guidance may not be appropriate.

Strict infection control procedures must be followed with patients infected with a multiresistant Gram-negative bacteria.

  Page last edited: 22/05/2009

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.

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