Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
In Reply: We wish to emphasize
that in our study imipenem was not selected as a single agent to
replace late-generation cephalosporins. As indicated in the
"Methods" section, empirical imipenem use remained restricted to
prior infectious disease approval except during the first 72 hours in
intensive care units. A wide variety of alternative parenteral agents
was allowed and encouraged throughout the hospital with routine
"antibiotic streamlining" according to culture results.
Piperacillin-tazobactam was introduced in 1996 without restriction.
However, approximately one third of our ESBL-producing
Klebsiella isolates are resistant to this agent, possibly due
to multiple or high-level β-lactamase production.
Rahal JJ, Urban C, Segal-Maurer S, Horn D. Control of Outbreaks Due to Organism Producing Extended-Spectrum β-Lactamases—Reply. JAMA. 1999;281(12):1080-1081. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-12-jbk0324