Multiresistant Gram-negative Bacilli
Please note: This is for information only.
Refer to local guidelines for treatment recommendations
- 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. 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 multi- resistant E coli sepsis:
- Recurrent urinary or biliary tract sepsis particularly where multi-resistant isolates have been previously identified from clinical specimens.
- Recent treatment with a quinolone antibiotic eg ciprofloxacin.
- 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 eg gentamicin resistant coliform in urine, first line therapy must be discussed with a 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.
Main clinical infections:
- Abdominal , Biliary and Urinary Tract Infections.
- Hospital-acquired pneumonia particularly ventilator-associated.
Usually sensitive to:
- Nitrofurantoin (except proteus sp.)
- Carbapenems (imipenem, meropenem)
Varying sensitivity to:
- Piptazobactam (tazocin)
Usually resistant to:
- All cephalosporins (cefradine, cefuroxime, ceftazidime, ceftriaxone, cefotaxime)
- Quinolones (ciprofloxacin, levofloxacin)
- Gentamicin, tobramycin,