Résistance bactérienne par β-lactamases à  spectre étendu : implications pour le réanimateur

In parallel with the massive use of β-lactam antibiotics, β-lactamases are evolving towards genetic diversification, extension of spectrum of activity and dissemination among Enterobacteriaceae species and non-fermentantive Gram-negative rods such as Pseudomonas spp and Acinetobacter spp. Detection of extended spectrum β-lactamases (ESBL)-producing strains requires a combination of specific microbiological methods. ESBL-producing bacteria are responsible for many local, national and international outbreaks which frequently originated in ICUs. Infections by these strains represent an increased risk of therapeutic failure and are associated with longer duration of hospital stay and higher hospital charges. Based on clinical data, carbapenems are the drugs of choice for serious infections caused by these strains. Surveillance of infections produced by ESBL-producing organisms is recommended in ICU. Control of spread can be achieved even in endemic ICU settings by using strategies which combine rational antibiotic use, promotion of hand hygiene, screening for patient carriage, and contact isolation for carriers.