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Evolution and Clinical Importance of Extended-Spectrum β-Lactamases*

Louis Rice, MD
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*From the Cleveland Veterans’ Affairs Medical Center, Cleveland, OH.

Correspondence to: Louis Rice, MD, Medical Service III (w), Cleveland Veterans’ Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106



Chest. 2001;119(2_suppl):391S-396S. doi:10.1378/chest.119.2_suppl.391S
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In the process of evolution, bacteria have acquired well-developed mechanisms of resistance to an extensive array of hostile substances. This time-tempered system of defense is so intricate and adaptable that contemporary medicine has been hard-pressed to maintain an advantage. In this article, the processes responsible for bacterial resistance to extended-spectrum cephalosporins are reviewed. Particular emphasis is placed on the extended-spectrum β-lactamases that have emerged to provide bacteria with formidable resistance to modern drugs. Avoidance of this problem requires limitations on extended-spectrum cephalosporin usage. While carbapenems are clearly the treatment of choice for infections caused by these pathogens, empirical use of β-lactam/β-lactamase inhibitors such as piperacillin/tazobactam has been associated with reduction in the prevalence of cephalosporin resistance.

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