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:

  • Amikacin
  • Nitrofurantoin (except proteus sp.)
  • Carbapenems (imipenem, meropenem)

Varying sensitivity to:

  • Piptazobactam (tazocin)
  • Co-amoxiclav

Usually resistant to:

  • Amoxicillin
  • All cephalosporins (cefradine, cefuroxime, ceftazidime, ceftriaxone, cefotaxime)
  • Quinolones (ciprofloxacin, levofloxacin)
  • Gentamicin, tobramycin,