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Journal of Medical Microbiology logo Journal of Medical Microbiology

Volume 74, Issue 2

Preserving the antimicrobial arsenal: exploring alternatives to carbapenems in ESBL battles within the southeast of Ireland Open Access

Abstract

Carbapenems are usually employed as first-line antimicrobials against bacteria harbouring extended-spectrum beta-lactamases (ESBLs). These enzymes confer resistance often to multiple classes of antimicrobials.

This indiscriminate use of carbapenems and the inevitable development of carbapenem resistance have prompted the need for carbapenem-sparing strategies.

The non-carbapenem antimicrobial susceptibility patterns of 60 ESBL-producing (ESBL-PE) isolates responsible for bloodstream infections, in 2022–2023 inclusive, processed at our institution were reviewed.

The non-carbapenem antimicrobial susceptibility patterns of 60 ESBL-PE isolates from bloodstream infections during the study period were determined. was the most common species isolated (87%, =52), with the majority of cases (73.3%, =44) originating from a presumed urinary source. Temocillin (TMC), mecillinam (MEC), cefiderocol (FDC), amikacin and fosfomycin (FOS) displayed excellent activity against all ESBL-PE isolates tested, with susceptibility rates of≥85%. Ciprofloxacin and amoxicillin–clavulanic acid were the least efficacious agents, with susceptibility rates≤20%.

TMC, MEC, FDC and FOS offer promising alternatives to carbapenems, demonstrating efficacy against ESBL-PE. The use of these agents not only broadens the therapeutic arsenal against ESBL-PE but also mitigates the potential for escalating carbapenem resistance, especially in regions where the incidence of carbapenem resistance is increasing.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): antimicrobial resistance , antimicrobial stewardship , antimicrobials , carbapenems , Enterobacterales , ESBL , extended-spectrum beta-lactamase and surveillance
© 2025 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between the Microbiology Society and the corresponding author’s institution.
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2025-02-05
2025-12-14

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Preserving the antimicrobial arsenal: exploring alternatives to carbapenems in ESBL battles within the southeast of Ireland
J. Med. Microbiol. 74, 001955 (2025); https://doi.org/10.1099/jmm.0.001955
/content/journal/jmm/10.1099/jmm.0.001955
/content/journal/jmm/10.1099/jmm.0.001955
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