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ESBL Bacteraemia — SCE Infectious Diseases MCQ

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ModerateAntimicrobial StewardshipESBL BacteraemiaSCE Infectious Diseases

A 60-year-old woman is admitted to hospital with severe sepsis. Blood cultures grow Escherichia coli producing an ESBL (CTX-M type). The organism is resistant to Ceftriaxone, Ciprofloxacin, and Co-amoxiclav, but sensitive to Meropenem, Piperacillin/Tazobactam, Amikacin, and Nitrofurantoin. She has E. coli bacteraemia with urinary source. What is the most appropriate definitive treatment?

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Correct answer: A — Meropenem IV

For ESBL-producing E. coli bacteraemia, carbapenems (Meropenem or Ertapenem) remain the treatment of choice. While the MERINO trial showed non-inferiority of Piperacillin/Tazobactam was not established for ESBL bacteraemia, subsequent data has reinforced carbapenems as preferred for ESBL bloodstream infections. Piperacillin/Tazobactam may be considered for de-escalation in selected clinically stable patients with lower-acuity infections. Nitrofurantoin achieves negligible serum levels and cannot treat bacteraemia.

Reference: BSAC 2023 – ESBL treatment; NICE NG51 2016 – Sepsis